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� �� <br /> � Crty of Qrono � �(p � <br /> Building Permit Application <br /> for New Structures or Additions <br /> � Mailing Address: permit number: �UL.S^ O/� <br /> PO Box 66 <br /> � �Q Crystal Bay, MN 55323-0066 Date received: �,/-3 '/ <br /> Street Address:� n •� / Received by: /yf 7� <br /> '' ,� 2750 Kelley Parkway I �� � 1� <br /> y�' �` Orono, MN 55356 v ��'� Plan review fee: 3�. S <br /> �'�kesMo��' Main: 952-249-4600 Total Fee:�� a �� s f� � <br /> Fax: 952-249-4616 www.ci.orono.mn.us � <br /> This apptication#om�r must be com�tet�d ir�fufl arrd aft required irrfarmation must be subm ed. �K <br /> Incomplete applications wiN be returned. (Please print) <br /> GENERAL INFORMATION• , <br /> Job Site Address: 3 7 q � <br /> Will this be a Parade of Homes, Remodelers S owcase Home or other Display Home? ❑Yes No <br /> li yes,a specia!event permit is required with Police Department and City Counci/approval 60 days prior to the event. Shutile bus service wi be <br /> required unless applicanf demonsirates s�cient on-site parking is ava1la61e. Non-permitted events wil/not be allowed. <br /> CONTRACTOR/APP�A�T,�FOR�.M�ATION: <br /> Name: {-��,� <br /> State License# Expiration Date: '3�3l' <br /> Phone: cell - office b[(2- <br /> Mailing Address: Q� ry�? Cit : <br /> Contact Person: � � ZIP� $ <br /> Applicant is: ontractor Homeowner (Clrcle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INF1O�RMATIQ� <br /> Name: �-ItIIP � t`�.��► ������ <br /> Phone (day): u - <br /> Address: 1�. �']� �,�P � City: �q� ���f� ZIP: �-�j � <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER I OR ATION: <br /> Name: <br /> Phone(day): - <br /> Address: C� : p Z�p: 5' L�l� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro'ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4,Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction �ingle Family with ❑Accessory Bldg./Garage <br /> �Addition attached garage ,�'Deck ❑ Public Sewer <br /> Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence �rivate Sewer <br /> ❑Other: (specify) ❑ Multiple Family/Condo ❑Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may require ❑ Commercial ❑Storage <br /> MCWD review 8 permits. ❑ Industrial ❑Warehouse �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other:(specify) �Other(specify <br /> 15320 Minnetonka BNd Si2 tezv� ��G� <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ °���0�' <br /> Packet Last Updafed.' August 2015 <br /> Page 21 <br />