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C�ty of Orono � <br /> Buildin Permit A lication � � <br /> J pp f � ' <br /> for New Structures or Additions <br /> Mailrng Address: 3 �.(g <br /> ig,0,�.\� PO Box 66 Permit number: p la - �� �1 <br /> �� � <br /> �/ Q , O� Crystal Bay, MN 55323-0066 Date received: L -3 0 - � � <br /> �'z� L <br /> � Received by: � <br /> �� 1y'��'�'�;`-� � r StreetAddress:' <br /> ���'� ���%�•�,";�k'd G�� 2750 Kelley Parkway Plan review fee: o�DI o�2 - f�0 3 � <br /> �t�`��'-r-��/ Orono, MN 55356 �a y ���� <br /> \jfEs�os� <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 appfications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �1"�' p �- �� <br /> � r 1�CG u�n � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> !f yes, a specral 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 I APPLICANT INFORMATION: <br /> Name: /�,c�.,I �c,!(.�� CL��•�r_<��fi�.� <br /> State License# �C.� '7 � Expiration Date: 3-�p�c� <br /> Phone: �� office) (cell <br /> Mailing Address: � ,;�/ ,,,,r , �p .s3 � Cit : / :,,���,f„ ZIP:�,5"y � <br /> Contact Person: [�., ;`�,�,�;..^ Applicant is: ont ac / Homeowner (Circle One) <br /> Email and/or Fax: �j_�;�,/�hC�iQ�'���f,;��%,�.,,,.u�.,•� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �c5z,•,aCa .l�e,cs� � <br /> Phone (day): ���_ y j_ 7��, <br /> Address: ��_�y�d Cc+��- �,� City:(���� ZIP: ��s�y� <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: �.:�� M���{.� ,(�eS+�. S{��v <br /> Phone (day): �'�-�5�,_�Gy� <br /> Address: �?y�' f�;�v�t,,, City:C�a�� ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� <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) c r ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> '"`Any earth movement may require ❑ 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.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �".pv�;l <br />