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1 <br /> . , � � <br /> City of Orono _ .�n� � <br /> Buildin Permit A lication � � <br /> Vr <br /> 9 pp , � <br /> for New Structures or Additions �` � <br /> Mailing Address: U <br /> �j,�,�. PO Box 66 Permit number: <br /> O O � Crystal Bay, MN 55323-0066 Date received: <br /> a�, <br /> ,; <br /> 2+� <br /> � �����-"''��- Received by: <br /> ,� , .4��, �, Street Address:� <br /> �'�c, "� '�� �ti/ 2750 Kelley Parkway Plan review fee: <br /> L9kESH��`'� Orono, MN 55356 <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: ���5 i C��� tF('c'�✓� �-� ,��'�� ��A,�' <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/APPLIGANT INFORMATION: <br /> Name: ��i l� n> SY <br /> State License# Z c� S j "7�'S Expiration Date: �-31- Z�i O <br /> Phone: office cell <br /> Mailing Address: ,�, �,� Lp�,�� City:Lar-c�fo t,J. ZIP: �3S''7 <br /> Contact Person: -T�j�.�,,�, -5}c�,� Applicant is: Contractor / Homeowner (CircleOne) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: '���/ j ��ir�,../ �b�d✓�, <br /> Phone (day): (� /�L �/Q GJ'� L <br /> Address: y3SS ��7 r�' �� � � City: /l/�l� �'iq„� ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGII�FER INFORMATION: <br /> Name: 1'A.� -�c,.M a� �S/t:,1 <br /> Phone (day): �t2 Zso Ya� <br /> Address: _0� ��,� � City:ff4'w,��,�►.� 1S'e,4�.ZIP: SSj.(�� <br /> Email and/or Fax: � .�..�1 bL,�,—, �;,-�- � pL . c f� <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 f�'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.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ <br /> - 18 - <br />