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,i � <br /> . 6C� , . . � <br /> I�v � Ci of Orono o � � <br /> ��� � . . . 12 <br /> �, Building Permit Application <br /> for New�Structures or Additions <br /> AAa111ngAddress. � °-��j�°r�UmE�:"�� _.��L.J.-s-. -� �. <br /> �0,�. PO Box 86 - ...•.` . - <br /> � � Crystal Bay,MN 55323-0088' 't7�t�.���lt���;,,,.,,;, �. - : .� ./d . <br /> �--� . 's� -�a;:., :=. <br /> �}_-=_. <br /> SYree t Addr&as:' ' �'�!�,'��:��`�-- " _ _ " <br /> � � ti:;7�1e:�.;•�=ie:; _ _.��u� � . �.:i;� : =.. :�""" . . •�•n <br /> 2750 Kelle Parkwa " .o„ , �. . ,`. ;;9� <br /> •. �.. <br /> � L •.. .2!I�..R ���§i�'y.�_:. .�1... <br /> y y :P��:��a�+►;��...,:: -;,,,,; 4,.,;=..,� <br /> gP Orono,MN 5�356 :_ �'��.'°•-• ��:;�•-.�•'�!.. -_ • . . <br /> ,��;. <br /> �YW�++WM�5' <br /> �. F ��� F....n.: <br /> (�in: 952 249�600 Fax: 952-249-4818 i�rvv.cl.orono.mn.us r��!��� � ���' �� <br /> This applicatian form must bra campleted in full�nd all required ir�formatfon must be submitted. <br /> Incomplete epplications wili be retumed. (P/ease prir�tJ <br /> l'3ENERAL INFORMATION: <br /> Job Slte Addness; a ,s J4 � bo�' S �'• ('y rnr� �1I S � 3�l'� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other isplay Hame? Yes o <br /> Myes,a speate!evenf pe►rmltls requtred w►Ith Po/Ice DeAerbn�ent�d C�7y Coyncll approve!60 days prtor to the evenk 8huttla bus aeroice wiif be <br /> rgqulre�ll unless appNcerrt demonsbetes�enf crt-sHe perWr►g!s ave8eb/e. IYon pemit(tedevents wiR nnf be alloweaL <br /> CONTRACTOR/APPLI CNNT INFORMATION: <br /> Name: �",��F'� Sw•�d ��.t, <br /> State License# �0 5S q6 iS Explretlon Date: -]���� <br /> Phone: 4- �S off'�ce cell <br /> Mailing Addreas: b�r� �, 1 �r�r CIt • .+� t ZIP: <br /> Coniad Person: ��ah ' Appli+carrt is: ontractor / Homeowner �corUe one� <br /> Email and/or Fax: q S�- �.�-k- �'i��-9 <br /> PROPERTYGWNER INFORMATI�N: <br /> Name: Gl�.�f Pc � <br /> Phon�(daY)� iv 1�- '�) - 3 L ' � <br /> Address: ���S' {�a t� A�v( ' CItY: WR w Z4f'�. ZIP: S s ; 1 ( <br /> Email and/or Fax ' '� ' � ' <br /> ARCKRECT J ENC3INEER IAIFORMATION: , <br /> Name: , � 9 <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email andlor Fax: <br /> PROJECT INFORMATiOId: <br /> 1.'lype of ProJect 2.Propo�ed Use 3.St�ucture 7ype 4.Sawage Dkposal8� <br /> Wa�r Supply <br /> ❑N�r CanatrueUon ❑Single Famity with ❑Residence <br /> ,�Additlan aNached garage ❑Garage 1 Accsssory Bldg. ❑Public Sewer <br /> coeasory Building �Z,X[(p ❑ Single Family with ❑Dec�cc <br /> ❑Reloc�tion d�ehed garage ; ❑OfticelCommerolal ❑Privete Sewer <br /> ❑Other:(spedfy) ❑Multiple Famdy/Gondcl� ❑Warehause <br /> ❑Publlc �'Storape ❑Public Wa�r <br /> '�My eerth moverneet may requlre ❑Comrnemial , ❑Other(apecify) <br /> NCWD revlew 8 permlb. ❑Industrial' ❑Private Well <br /> Minnehaha Creek WaEarahed Dlstdct(MC1Nt» ❑pther.(apeclfy) , <br /> l824Z Minnetcnka Blvd � � <br /> Deephaven.MN 55391 , <br /> Phana; 962-471-0580 <br /> Feu �52�71-0882 <br /> Estlmated Con�truction Valuaiion(exduding land) , � <br /> Lasl Updated: 9/29/2009 e <br /> ' -17- <br /> Z 'd . Xb.� 13C213SFJ� dH WdZS �S 0 i OZ SZ �eW <br />