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440 ATT-AC R E D o2 SET5 <br /> T (DF 5EPTTC IDESI6ti 4- <br /> City of Orono SET OF P60L T�vfo . <br /> Building Permit Application <br /> for New Structures or Additions 5 a �0 — <br /> �0 MaihPO Boxr66 Permit number: � (� <br /> Crystal Bay, MN 55323-0066 Date received: <br /> a (t <br /> Received by: <br /> a Street Address:' <br /> ��, Gtiti 2750 Kelley Parkwayply CJ �� Oi�LGj Orono, MN 55356 r d CIG 1J /U l Ian review fee: <br /> kESHOg' <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.usyxt1w rew d to . q-1L <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 96 q5 X 4T ERTOeA)y h014 D <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> /f 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-site parking is available. Non-permitted events will not be allowed. M l4v BE <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: trRI 6V -Q+fi1E S 6cr1V5—t ZUC'T-TC-t,-' <br /> State License# E G 531 cr(0I Expiration Date: 3 -3) a0/3 <br /> Phone: (rtLo3 q7q-311 7 (office) (G 1a) 36cr_- 3 7 3 G (cell) <br /> Mailing Address: P0 _ UX 30 to City: J`' t e_ to_rn!ZIP: SS <br /> Contact Person: �O-E M C 1:::,41:--210-,/ Applicant is: ontrac or Homeowner (Circle One) <br /> Email and/or Fax: Q©r`C) 'a m c s. <br /> PROPERTY OWNER INFORMATION: <br /> Name: PETE + 4vvit>,q t)4-,V 0UER l3EKG <br /> Phone(day): 6z,( - -155 a <br /> Address: City: ZIP: <br /> Email and/or Fax amahac+ . ✓►�, �sano�t� kc 0. CC�n,4ltire , ccs-, <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: p. F. P. 4- <br /> Phone(day): 67103 7F0- SDO y <br /> Address: 9t 00 NA-L7-17,*0RE s'r, V.- - ;' Joe, City: BL,4xw E ZIP: YLLA q <br /> Email and/or Fax: d Ss cl es <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ONew Construction Single Family with Residence <br /> ❑Addition attached garage ❑Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑Relocation detached garage ❑Office/Commercial RPrivate Sewer <br /> ❑Other:(specify) ❑Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage ❑ Public Water <br /> "Any earth movement may require ❑Commercial ❑Other(specify) <br /> MCWD review&permits. ❑ Industrial Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other:(specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacMtk.org <br /> Estimated Construction Valuation (excluding land) <br /> Packet Last Updated: 03-06-2012 — �� Q Q. 0 0 P DO 1— <br /> S -v//z <br /> -21 - d0' i <br /> S57 , poo, "o newh� pv� <br /> J013 -oloZb <br />