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. . , 4, <br /> ' City of Orono <br /> Building Permit Application <br /> for New Structures or Additions . <br /> Mailing Address: Permit number: 6 —��/ <br /> .¢,�,�. PO Box 66 <br /> O Q Crystal Bay, MN 55323-0066 Date received: 'J� .3 d � ���ys <br /> ,� �� �., � Street Address:' Received by: � `��' <br /> �� ti 2750 Kelle Parkwa �� �; '� � <br /> �� `' � Y Y Plan review fee: � ) ( �/(o . <br /> '�y � Orono, MN 55356 J1�� r— <br /> kEsxog' <br /> -__= Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www ci orono.mn us � ���'�. �S <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: G,., <br /> Job Site Address: :312"1 �.�5��� <br /> Will this be a Parade of Homes, Remodelers howcase Home or other Display Home? ❑ Yes � No <br /> If yes, a special event permit is required with Police Department and City Counci/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: j h�,a�r Z� �t�� <br /> State License# Zv��P 43 i5' Expiration Date: 3 - 3�-n� <br /> Phone: q5Z— �:�i'7 - S59v (office) G�12- 'zc�� - �zc��cr (cell) <br /> Mailing Address: -jKa'I w�y�2k¢•, c�,��Z City:,+.�rnnt-,p41;�i ZIP: S 5�{z.b <br /> Contact Person: 5�tN (�kSfi,FS�N Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: ���,� � S-�p��.J����L �t�� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �ec� �<ka5 <br /> Phone (day): :�12.- '32�"-;,,)v� <br /> Address: 3 i�-� (��=� 4 Z �'' City: c.�r�.�+� � ZIP: <br /> Email and/or Fax � <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: '�hEF- L ,�n.�s-� <br /> Phone (day): 2- - � 20- 2 5h - 65'1S <br /> Address: 3�o w lo �-t o� Cit : f C(�.� �. ZIP: SG3o <br /> Email and/or Fax: SA.L 2�� a d NF ,, �N� .�o,,,� <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> �New Construction �.Single Family with �Residence <br /> ❑Addition attached garage Garage/Accessory Bldg. � Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> [�Other: (specify) �q'�n1�5 Co�.s"� ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage �Public Water <br /> **Any earth movement may require ❑Commercial � Other(specify) <br /> MCWD review&permits. ❑ Industrial TaN.'� �.�J'T ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �0 0 .n �o '' <br /> � <br /> - 18- <br />