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. . Z <br /> � � �la� X <br /> ' �mh� ���� ►� <br /> � <br /> �-�- � --- ._ <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> - — Mailing Address: <br /> �� � ` �� PO Box 66 Permit number: <br /> //�� ���`� Crystal Bay, MN 55323-0066 Date received: <br /> �l <br /> �;�,,. -._ • Received by: <br /> ���a y ��,�_r,_ s,�; Street Add�ess: <br /> `� ��� ' �'/ 2750 Kelle Parkwa <br /> �,nL ��� ������ Y Y Plan reviewfee: <br /> � '� Orono, MN 55356 <br /> 9AES%i�4i <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 applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 3`is�'�'1 Ch�i��� �1�c- <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/APPLICANTpINFORMATION: <br /> N a m e: �c QG�ic;� t oNS31YU.f.;�'in SY�f� <br /> State License# �7 23 J6 Expiration Date: 7-�( -2�%1�(' <br /> Phone: R Z-�j 3 1- 7h��( (office) (cell) <br /> MailingAddress: 7Evl �`1s� �� • r,t- Cit : �� �n ' ZIP: �51zy <br /> Contact Person: 1� i� � Applicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: M��ni�Q,a.����v� ��.,�Struc�ch�coW. <br /> PROPERTY OWNER INFORMATION: <br /> Name: i-`��� Lr.��u�a� _ <br /> Phone (day): I - 7C�'3-'j]`'S- 7�5�i <br /> .,,. -. c�c ��r:.�� ziP: 5.5SSE <br /> Address: ��s'� C'In,,:ry7 G�� Y� <br /> Email and/or Fax ���ay, z.���tu�n2�G' .;Me�.z�,co� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: �� Aynar+�t �:��w� •- 7�rt5cz �� �1►�c;�� - <br /> Phone (day): �.`k?�`I�-7GU� <br /> Address: 7L-Ul l Y� ST �.,�xst City: �p� �����/ ZIP: 5J�1�-� _ <br /> Emailand/orFax: 1e�tSc� (3 >�c�.w�c�a�� +sr�ill�c-•Cu+'^ f��x: �{52-`�3 - 13�.$ <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 �Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑ 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) $ ��3 ��� <br />