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� �l�t ��d ����1 <br /> - � <br /> � � ��,� �ono <br /> ���'�-� �� �� � 4 lication <br /> pp <br /> {��l,��s �� �� � or Additions <br /> ,.__� /�, . ��� � �' GCe� a oio- o0 <br /> �/ 0 �'/Y �� � Permit number: <br /> 'g' 1�, d��` / / � - p <br /> 0 4, ii i/1 �l/� _ G�� 3 Date received: O� � /D <br /> �(M/` U <br /> €��+t �/� Received by: <br /> a � r,�,�.;_ /�IQ /� � l`� <br /> �� ��, ���`� � Plan review fee: <br /> lq�� � <br /> \kESH�� /� ��� <br /> �jn�/� /�/ Total Fee: <br /> M� �� "" _ _ �rono.mn.us <br /> T �{ ,p II required information must be submitted. <br /> „�. <br /> eturned. (Please print) <br /> GENERAL INrvrcmA i iUN: <br /> Job Site Address: (, 3 0 0 �o�o � � ;5 �s���� � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the svent. Shuttle bus service wil be <br /> required unless applicant demonstrates sufficient on-site parking is available Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANTINFORMAT <br /> Name: <br /> State License# �c� r .�. ,�.. ...,.� _ ,_. �, .,.,, ,�: ,� _, ,,.,:. .� , <br /> Phone: (cell) <br /> Mailing Address: <br /> Contact Person: ����—�"� - (Circle One) <br /> Email and/or Fax: � <br /> PROPERTY OWNER INFORMATION A C�1 �I v4�' `k� ' `� <br /> Name: S'G �F�- � � <br /> Phone (day): 9 S a- Q �� � � �� �� ��� <br /> Address 17 3 `t�' V* >SIT Y 7 <br /> Email and/or Fax <br /> _. __ <br /> _ <br /> ARCHITECT/ENGINEER INFORMA <br /> Name: <br /> Phone (day): <br /> Address: ,, .., ,.:_ _ . .,,... , .. r .:.. ,�. .. _..... _ ,. _, __ . <br /> Email and/or Fax: <br /> ___ __------ <br /> ___- <br /> ____._ __.____ .----- - <br /> PROJECT INFORMATION: G, I �f ((' �— �G,�{/� `� �-2 G� <br /> ------ <br /> 1.Type of Project Disposal 8� <br /> ❑ New Construction �I��(/�� <br /> J�� �v�"`��� I `�" iuPp�Y <br /> ❑Addition l ��n �py�j U'�iti1`—� �ewer <br /> �Accessory Building „� � � �-P� <br /> ❑ Relocation f 5ewer <br /> ❑ Other: (specify) �� <br /> ------------ <br /> _ Jater <br /> *'Any earth movement may require - - ~ - " - ' " - ' <br /> MCWD review&permits. ell <br /> Minnehaha Creek Watershed District(MCWD) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excl <br /> Last Updated: 9/29/2009 <br />