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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> PO Box 66 Permit number: CAVY U l) % ? <br /> Crystal Bay, MN 55323-0066 /I� Date received: 9 all i- l <br /> Jr <br /> Street Address:' d�P Received by: <br /> y 2750 Kelley Parkway <br /> Orono, MN 55356 Plan review fI <br /> kFstto�` Main: 952-249-4600 Total Fee: �7SG�L� <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This appiication form must be completed in full and all required information must be submitted. <br /> GENERAL INFORMATION: <br /> Incomplete applications will be returned. (Please print) <br /> L <br /> Job Site Address: 13 / 5 -T c v k- tu-,,ct <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-sfte parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/AP (CANT INFORMATION- <br /> - <br /> Name: <br /> State License # 6) Expiration Date: . <br /> Phone: cell l _ -� =� -{4/ (office) 9S� �� �� rg <br /> Mailing Address: 'rr ' o Cit : v ZIP. <br /> Contact Person: Applicant is: ontracto / Homeowner <br /> Email and/or Fax: �. (Circle One) <br /> PROPERTY OWNER INFORMATION:. <br /> Name: Ll�� 1=� �� `� �% <br /> Phone (day): <br /> Address: i w� City: (I-CFk c- ZIP <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: rriflkl: ZIP. <br /> Email and/or Fax: <br /> ARCHITECT/ ENGINEER INFORMATION: RECEIVED <br /> Name: <br /> Phone(day): <br /> SEP 2 � �Uii - <br /> Address: C' : ZIP. <br /> Email and/or.Fax: <br /> R NO <br /> PROJECT INFORMATION: Descri tion of prosect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> ❑ New ConstructionWater Supply <br /> Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial ❑ Public Sewer <br /> ❑ Relocation detached garage. Residence <br /> Other.(specify) V2t. �� � ❑ tic <br /> Multiple Family/Condo ❑ Retaining Wall(s) (❑Compliance certificate <br /> ❑ Public 4-feet or greater may be required) <br /> **Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse <br /> Minnehahe Creek Watershed District(MCWD) El Public Water <br /> 15320 Minnetonka Blvd;Minnetonka,MN 55345 ED (specify) Other(specify) <br /> Phone: 952-471-0590 / Fax: 952-471-0682 ❑ Private Well <br /> www-mi nnehahacreek.or� <br /> Estimated Construction Valuation (excluding land) $ -3 Civ <br /> Packet Last Updated, January 2016 <br /> Paqe 21 <br />