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L <br /> City of Orono ���1# (�# <br /> Building Permit Application �- `�S' <br /> for New Structures or Additions <br /> Mailing Address: o?a((_001/7g <br /> �,O,� Permit•number: <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: to /(,c, // <br /> I "" Received by: <br /> a �. Street Address:' <br /> '��cr �, +i Gti``' 2750 Kelley Parkway Plan:review fee: <br /> EsiYo�`� Orono, MN 55356 <br /> -- Total Fee: 17?, <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <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: 95'o Wt I IoLd U t°Pw 0 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ,j 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-site parking is available. Non permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: LArry ©(Sort. 6,us +o vv._ -}1,43 ert e5 <br /> State License# a 05'1;3'0 7 '7/ Expiration Date: ao/a_ <br /> Phone: I](03 - a .%•-ail tno (office) ?6 '• — if76-coo 5 (cell) <br /> Mailing Address: •• w - Lai-Le kJ Cit : • /t , ZIP: <br /> Contact Person: L p rry p I S cih.1 Applicant is: ontract.r / Homeowner (Circle One) <br /> Email and/or Fax: La rry D is c r_ 2 + MS k) • C o <br /> PROPERTY OWNER INFORMATION: <br /> Name: '3'v 5 . ± Al y5 S a kck A t VC-- <br /> Phone(day): Lo- r. Ia fie_ <br /> Address: Q 5 O IN i Ho c V C 4,w ()r City: 0--o v O ZIP: 5-53 54 <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ` --- <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction X'Single Family with ErResidence <br /> ❑Addition attached garage 0 Garage/Accessory Bldg. ❑ Public Sewer <br /> 0 Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocationn detached garage ❑ Office/Commercial ❑ Private Sewer <br /> Other:(specify) Oe c:k Sica r5 ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public El Storage ❑ Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. 0 Industrial <br /> MCWD CI Private Well <br /> Minnehaha Creek Watershed District <br /> (MCWD) ❑ Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> 00 <br /> Estimated Construction Valuation (excluding land) $ , ,Z.0 o` <br />