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�� �� � � � <br /> � �� .�, � � � <br /> . , .� � , ;.i ���� <br /> ` . � Cit of Orono �� ,_ <br /> � y �3�9- �� <br /> Building Permit Application ; <br /> for New Structures or Additions <br /> —� Mailing Address: <br /> /��v�,�� PO Box 66 Permit number. �D!/-bb/p� � <br /> .,y Q� Crystal Bay, MN 55323-0066 Date received: <br /> �� �� '� =- � Received b <br /> `,a '��'',�� ,,�� Street Address:' y� <br /> \�'� �,y �� ��� 2750 Kelley Parkway Plan review fee: `�' r � %. �� �� <br /> �L � � , � <br /> �E S H Og'� Orono, MN 55356 �U j / ` v v� 3� <br /> � ---`� Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This appiication form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: ^ <br /> Job Site Address: � � ��5� �' ' tiC� ,� �'1 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> /f yes,a specia/event permit rs required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service�i/ e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will nof be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: S��G hr� ,�u� f�^(,7 <br /> State License# �00C,�o131 D Expiration Date: 3/.3! aU/ <br /> Phone: �1c�3 �3� �3L� (office) (�/,?�5'05",��� (cell) <br /> Mailing Address: �gJy-L <.ur� C�t �___._._ ���e/zc� ZIP: y <br /> Contact Person: , , r ,. Applicant � : Contractor Homeowner �c���ieo�e� <br /> Email and/or Fax: `� �rC GA7Si�-C�IrI -.------' <br /> PROPERTY OWNER INFORMATION: I <br /> Name: {Z�U,nJ ���I'� $iee{�►6r�'�/ <br /> Phone (day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax <br /> .�,� <br /> ARCHITECT/ Ef�G1N�ER�NFORMATION: <br /> __._ .._. <br /> __. <br /> ame: - <br /> ...�._.. <br /> .__ <br /> one day): -..�..._ <br /> Address: - - it : ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1. Type of Project I}, ♦ ' 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> j��)5`'}, � Water Supply <br /> ❑ New Construction J 1 ❑ Single Family with ❑ Residence <br /> ❑ Addition ���reuc�� attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation �� �S'�V detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) 9 ❑ Multiple Family!Condo ❑Warehouse <br /> �C ❑ Public ❑ Storage ❑ Public Water <br /> *"'Any earth movement may wre ❑ Commercial ❑ Other(specify) <br /> MCWD review 8� permits. ❑ Industrial <br /> ❑ 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) $ <br /> � tG�►i � w►IU,�d�L;S • ti • � \ <br /> �J��►J�j 'f�Y�: � Q(�d i�'1 G'YV � f J �,/ �u, � �(.t.;C+►c ��n.}�f�tQ.. �X�-`,c,�,J �1,� (�C�'�____----. <br /> � IVI`U (N 'irJ 1 �'VlyYl ���s � l�`S ��;`�� � ��n�5� J�r 1' ,�(.U�" �h(f�'(/ � r�/�///��'�Ja <br /> J � ' � " "' <br />