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. . � _ P �i �� _ <br /> , , .-����-� � �� S � �' <br /> City of Orono b � �° .� �� <br /> � �� <br /> � Buildin Permit A licatio ��� � �� <br /> J pp � I� 0 � <br /> for New Structures or Additions - - �a�� �S <br /> Mailing Address: Permit number: /0 -��Gf� <br /> ���� PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �� D �/O <br /> �� �� �� <br /> � ����z��. <br /> II� t����`�' �.�� StreetAddress:' Received by: <br /> � .�.�� <br /> ��'� � z 'r� ��� 2750 Kelley Parkway Plan review fee: �� <br /> , ` �����. �,/ <br /> t�4.trESK 4�' ' Orono, MN 55356 �� �� _ � � �� / <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 prinf) <br /> GENERAL INFORMATION: <br /> Job Site Address: �� ��;;,,r��.�,�i �.�� fti�i:��� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [�-Pdo <br /> If yes, a special event permit rs required wrth 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 INFORMAT,��1N: <br /> Name: �'c/,.Lj� f�cj'e��� <br /> State License # ` � Expiration Date: <br /> Phone: __C �� ��j (office q Z - � " ' ' cell <br /> Mailing Address: ��� i�---p � '�� ;� .� '_ � � Cit : � �, . ZIP: �� <br /> Contact Person: Applicant is: racto / Homeowner (Circle One) <br /> Email and/or Fax: ,( , � .,' �� � �j, <br /> PROPERTY OWNER INF9 RMATION: <br /> Name: f,/����-�, <br /> Phone (day): <br /> Address: � ,:��,��„N ��� � City: ��,�/'/�J ZIP:��'�.3�',,� <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Add ress: C ity: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> tJ"New Construction ❑ Sin le Famil with �Nater Supply <br /> g y ❑ Residence <br /> ❑ Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> ❑ Other: s eci ❑ Private Sewer <br /> ( p fy) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "*Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review& permits. ❑ Industrial <br /> ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (sp�fy) � <br /> 18202 Minnetonka Blvd ,� ���1 �„��� <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ��'�� <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />