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n <br /> City of Orono\� <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> PO Box 66 Permit number: <br /> Q Crystal Bay, MN 55323-OJECEIVE Date received: <br /> Street Address:' OCT 2 5 ?017 Received by: <br /> y 2750 Kelley Parkway <br /> G� Plan review fee: <br /> Orono, MN 55356 <br /> �GxFsxo4`� Main: 952-249-4600 CIN OF ORONO <br /> Total Feer <br /> 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 /> GENERAL INFORMATION: Incomplete applications will be returned. (Please print) <br /> Job Site Address: S40 LJ,11" �S- CXR <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-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLIC INFORMATION: <br /> Name: <br /> State License # Expiration Date: . 3/ <br /> Phone: cell 7(03-' _Z 7 office 7-- <br /> Mailing Address, Z ..tee City:- ZIP: �S3 <br /> Contact Person: Applicant is: ontr c / Homeowner (Circle One) <br /> Email and/or Fax: e-K e - ( -`o <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone(day): to S 2 Zrt, y <br /> Address: Soo W iia _ C' : � ZIP: <br /> Email and/or Fax N , <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): S 2_2!Co _� <br /> Address: 4 ' city: Lo ZIP. <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: Descri tion of project:%,:- (2� MgS'o& 2r/rec, ) o��-CS c �1 X ix r <br /> 1.Type of Project 2. Proposed Use 3.Strucfure Type YP 4.Sewage Disposal 8 <br /> ❑ New Construction ❑Single Family with ❑Accessory Bldg./Garage Water Supply <br /> ❑Addition attached garage ❑ Deck <br /> E)Accessory Building ❑ Single Family with ❑ Office/Commercial El Public Sewer <br /> ❑ Relocation detached garage ❑ Residence <br /> ErOther.(specify) �' i/ Septic <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 S permits. ❑ Industrial Warehouse ❑ Public Water <br /> Minnehahe Creek Watershed District(MCWD) f er: (g ) 'er(spe ) <br /> 15320 Minnetonka Blvd;Minnetonka,MN 55345 n i <br /> Phone: 952-471-0590 / Fax: 952-471-0682 ❑ Private Well <br /> www.minnehahacxeek om <br /> Estimated Construction Valuation (excluding land) S ,oc,:, <br /> Packet Last Updated: January 2016 <br /> Page 21 <br />