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� <br /> � City of Orono \ I 6 �� <br /> Building Permit Application <br /> V <br /> for New Structures or Additions <br /> �.�; Mailing Address: Permit number: � C� —C`�� �/ <br /> �,0,�. PO Box 66 <br /> 0 �, O Crystal Bay, MN 55323-0066 Date received: `�'�2�'`�Z f�'—�( Z" <br /> �'���'"�'� • Received by: <br /> �.� �% -` ,, , Str�et Address:' <br /> \�r � �;;,� ��``' 2750 Kelley Parkway Plan review fee: �(i. / � <br /> \•q���o4� Orono, MN 55356 �Q�� _�C �� <br /> =_=_�' Total Fee: <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: f7�D �o�j ns S°y` R � O hDn 1� <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 approva160 days prior to the event. Shutt/e bus service will be <br /> required unless appficant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: ,!�/ ��r� �G� d s�n s <br /> State License# /a ya �s/� Expiration Date: 3-3/-�� <br /> Phone: �l�3- y'7�.- -� 7/�a (��) (�/�-a �6'2Ge(o3 (cell) <br /> Mailing Address: _{'. e . g , � �3� city: D,� /�,,6 ZIP: ,3�--,3�g <br /> Contact Person: �/ Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER IN�ORMATION: <br /> Name: ��c�,�o L D�e��-d-J <br /> Phone (day): <br /> Address: j 7!� L� Q City: 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: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> ❑ New 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 ❑ Private 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 8�permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) <br /> 18202 Minnetonka Blvd r.e T�.'r,o LJct�� <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0652 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � �i i �pd � �' � <br /> I ' <br />