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r � <br /> ` � C�I�1L����� <br /> W g <br /> City of Orono , ��. , <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailir►g�ddress: /0 —�D <br /> .¢,�,j�. PO Box 66 Permh number. o� � <br /> Q 0 Crystal Bay,MN 55323-�6 Date received: ���`�� <br /> � �, SYieetAddiess:' Received by: B� <br /> � Gti 2750 Kelley Parkway Plan review f�: �0 a <br /> 1q8,�o8� Orono,MN 55356 67./l (o%'S'i <br /> Total Fee: <br /> Main: 952-Z49�600 Fax: 952-249-4616 <br /> This application form must be completed in fuil and all required information must be submitted. <br /> Incomplete appticetions will be retum�l. (Please print) <br /> GENERAL INFORMATION: I � � � �� � � �3� I <br /> Job Site Address: , <br /> Will this be a Parade of Hames, Remodelers Showcase Ho e or other Display Home? Yes No <br /> //yes,e specia/evern permit Is required witl�Po/kk�Departmertt end City Courn�/approva/60 days prlor to the ever� Shuttie bus service wfi/be <br /> r�crired unJess applicant demonstrates sulffcieM on-site parking is availab/e. Non permitted everns wlll r►ot be a11ow� <br /> CONTRACTOR/APPLICAWT INFORMATIOM: , _�1 <br /> Name: ��U(� C� �P.IX��I ��C�/IG�a(e��C/� <br /> State License# Expiration Date: <br /> Phone: � � office celi <br /> Mailing Address: bUr Ci : ZIP: <br /> Contact Person: c Applicant is: ContraGtor / omeown �c�o�� <br /> Email and/or Fax: , � <br /> PROPERTY OWNER INFORMATION: <br /> Name: �� QS c�v'Q. <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER IWFORMATION: <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 Dispoeal& <br /> Wetsr Suppiy <br /> ❑�w Construction ❑Single Family with ❑Residence � <br /> [�'Addition �ttectied garage ❑Garage/Accessary Bldg. Public Sewer <br /> ❑Accessory Building [�Single Family with ❑Dedc <br /> ❑Relocation detacF�d garage ❑Office/Commeraal ❑Private Sewer <br /> ❑Other. (specify) ❑Multiple Family/Cando ❑Warehouse <br /> ❑Public ❑ orage ❑Public Water <br /> **Any�rth movem�nt may require ❑Commercial �Other(spec�fy) <br /> MCWD revlerv&permits. ❑ dustrial �S''�e�� Ol �rnrate Well <br /> Minnehaha Cr�k Watershed District(MCWD) �er.(speafy) <br /> 182U2 AAinrtetonka Bhrd <br /> Deephaven,MN 15391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> m hhc o <br /> Estimated Construction Valuation{excluding land) $ � (j <br /> Last Updated: 8/29/2�9 <br /> - 17- <br />