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' . <br /> , � City of Orono <br /> � Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number. �-���� `� C f``��i� � <br /> �Q A,O PO Box 66 � <br /> `V Crystal Bay, MN 55323-0066 Date received: �� -- ��� <br /> Street Address' ____ . Received by: �-1�� <br /> 2750 Kelley Parkway " � c� � --� � <br /> ---- --- - <br /> y � �_G f �> �;��j(('7� Plan review fee: ' � . � {,�, �, <br /> � L` Orono, MN 55356 <br /> , = <br /> � �. -�51�1-` ----�. ----�1— __ <br /> �kfSHO� Main: 952-249-4600 Total Fee: � / �-c' �� <br /> Fax: 952-249-4616 :���v�. � i_vr�_�n�,rriri_us ✓ �✓ <br /> This application form must be completed in full and all required information must be su mitted. <br /> Incomplete applications will be returned. (Please print) �,��s�}' �r%/z //S� <br /> GENERAL INFORMATION: � <br /> Job Site Address: �Q�� (j cty S ia�t T`�i 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 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/APPLICANT INFORMATION: <br /> Name: L-c�,��-cxi ��c�S, <br /> State License# ��y�� Expiration Date: <br /> Phone: cell 61� -`7 �( -- �t D� office <br /> Mailing Address: � ��. O ty;� ��:n.� Cit : �Id Il�� -e ZIP: <br /> Contact Person: �f l.av� Applicant is: Contractor / Ho eowner (Circle One) <br /> Email and/or Fax: �;+�a� _�,��YeA �v��5 •c���r, <br /> PROPERTY OWNER INFOR,MATION: <br /> Name: �% �% ''����ti <br /> Phone (day): <br /> Address: . �_-�.-������%"�'��� City: ZIP: <br /> Email and/or F� ��- ��'`�`{ � <br /> �f, <br /> ARCHITECT I E �` � I ��~ <br /> � i��� <br /> Name: <br /> Phone (day): � J 3�� . �!� <br /> Emaeand/or Fax �� � ��e�'t�� � C.'��` City: ZIP: <br /> �4 �2 , �' l3 <br /> �_� �.� -_�- <br /> PROJECT INFC J � �� <br /> 1. Type o Project l"'� ,� �j�j� 3. Structure Type 4. Sewage Disposal 8� <br /> ' Water Supply <br /> ew Constructior ��(-� � �%'��-� � ❑Accessory Bldg./Garage <br /> ❑Addition ❑ Deck ❑ Public Sewer <br /> ❑Accessory Buildirn ❑ Office/Commercial <br /> ❑ Relocation ❑ Residence �-Private Sewer <br /> ❑ Other: (specify) _ ❑ Retaining Wall(s) <br /> 4-feet or greater ❑ Public Water <br /> **Any earth movemei .,,,,,a� ❑ Storage <br /> MCWD review 8� perrr ❑ Industrial ❑Warehouse ivate Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) ❑ Other(SpeCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � f u 1 �'�J , D�V <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />