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� <br /> >.' <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> ���7' PO Box 66 Permit number: ID9 QL} <br /> � �� � Crystal Bay, MN 55323-0066 Date received: ,� ; <br /> I'� ��'� � � Street Add�ess:' Received by: <br /> �'F'l '�� �~� 2750 Kelley Parkway Pfan review fee: � <br /> 9kESH0g'� Orono, MN 55356 � S�C, UC� <br /> Pla-� �cvt� - �0 9-00 �.a. <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn us Total Fee: <br /> This application form must be completed in full and all required information mu be su�itted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: "Z�33 �s(� ��,�" � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> lf yes,a specia/event permit is required with Po/ice Department and City Counci!approval 60 days prior to the event. Shuttle bus service i!l e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed. <br /> CONTRACTOR/AP�ICAN_T,,,�IFO MATION: <br /> Name: rVt �NG <br /> State License# <br /> Phone: � Expiration Date: <br /> Mailing Address: office cell <br /> Contact Person: Cit : ZIP: <br /> LG lY1 Applicant is: ontractor / Homeowner <br /> Email and/or Fax: �� nJ� ���1 G' (Circle One) <br /> PROPERTY OWNER INFORMATION�� <br /> Name: <br /> Phone(day): <br /> . . <br /> Address: � <br /> Email and/or Fax V[�(�� � � G G C�t � ZIP: <br /> t� �(? �l� <br /> ARCHITECT/ENGINEER I RMATION: <br /> Name: N�- � �bi� � ��` <br /> Phone(day): <br /> Address: � � <br /> Email and/or Fax: Cit : ZIP: <br /> �bJ� <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use <br /> 3.Structure Type 4. Sewage Disposal 8� <br /> �New Construction �Sin le Famil with �Nater Supply <br /> ❑Addition g y ,�Residence <br /> attached garage ❑ Garage/Accesso <br /> ❑Accessory Building ❑ Single Family with �'B�d9� %�Public Sewer <br /> ❑ Relocation ❑ Deck <br /> detached garage ❑ Office/Commercial <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Private Sewer <br /> ❑Warehouse <br /> ""Any earth m� ❑ Public ❑Storage <br /> �mmercial ❑ Public Water <br /> MCWD review ❑ Other(specify) <br /> Minnehaha Creel �SUv•6� �,SCYIl� duStrial <br /> ther: s e ❑ Private Well <br /> 18202 Minnetonk ( p Cify) <br /> Deephaven, MN oZ0 Ua •av ,p�2G� <br /> Phone: 952-471- ��,� �c�i� <br /> Fax: 952-471-06 <br /> www.minnehahac a� 7/�S�'/ —P��� ' <br /> Estimated Coi ����ind) <br /> $ � <br /> - 18 - <br />