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� �, <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: D oZ—O� � $ <br /> ,,%�0,�\\ PO Box 66 _ <br /> %r� 0,,, Crystal Bay, MN 55323-0066 Date received: � <br /> �'k � <br /> �4�,a �y'�r��-,. ,,;�r Street Address:� Received by: <br /> \\'� � �� � ti l� 2750 Kelley Parkway Plan review fee: � �. � <br /> �.� �,� �F, � � <br /> \\tq�ESHQg,rii%' Orono, MN 55356 oZ�!oZ-00 3 � <br /> '__==�'� Total Fee: _ _ <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us s� -� l ;� . ?�`� <br /> This application form must be completed in full and all required information must e submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GElVERAL INFORMATION: <br /> Job Site Address: 3ib5 �S�o Cl��t� <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: �•1 J�7��v <br /> Name: o oop Lt-L �� <br /> State License# L S 3 T Expiration Date: 3-3 i- �►�f <br /> Phone: 951-�71 - o S p,� (office) 6I2-2�-7-Z�,�o (cellj <br /> Mailing Address: o A 2J�rfF- �v Cit : rIrIG�4r�uS ZIP: SS (o __ <br /> Contact Person: Sv�N (a�sTqF�o,n/ Applicant is: on r cto / Homeowner (CircleOne) <br /> Email and/or Fax: �v�N� SToNEwoo� Gow� <br /> PROPERTY OWNER INFORMATION: <br /> Name: I�JI�R..O + �� �2�1 ST2o�(,� <br /> Phone(day): <br /> Address: �,S�8 EDG E8�lc PC Citv:�OE�✓f�R��/�E nl�✓ZI P: S's+3/G <br /> Email and/or Fax � t.v��-dSrn�.St�,rOAA/� 0.0 f <br /> ARCHITECT/ENGI EER INFORMATION: <br /> Name: �G.�ff��t/OF.�22- /�ES�ynJ C���� <br /> Phone(day): yS2-�j3 - 8��1 <br /> Adc:ress: yp/ �5?' GI�K� STk6FT City:(.✓��ZA��F- ��l ZIP: 5�39! <br /> Email and/or Fax: <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) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ,�'Pubtic Water <br /> **Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Othef: (Specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Est�mated Construction Valuation (excluding land) $ 000 <br />