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�� �) ��►Z �1 <br /> City of Orono <br /> l <br /> Building Permit Application <br /> for New Structures or Additions �a�8� - 7� <br /> Mailing Address: Permit number: <br /> ���,�,� PO Box 66 <br /> ,\ � Crystal Bay, MN 55323-0066 Date received: // <br /> �'k '� <br /> �I �-. . Received by: <br /> `� }y {,�,� , �,� Sf�eet Address: �/• Q <br /> \�.�c, �����,�t� G�� 2750 Kelley Parkway Plan review fee: l / <br /> �.tR �<�"� � Orono, MN 55356 �D!�—OO� <br /> �?fEsxos'' <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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 2,(p,, � �''� ��j�, <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 servic will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATIpN: <br /> Name: � � �((� � "�c�Cl,'�-'f'�C J�� <br /> State License# Expiration Date: 3 3( �2 <br /> Phone: G.�72-�-l.��j - (office) S'%� ��f(✓` ?`{�j (cell)t�/z-���- <br /> Mailing Address: I���Z M�rv�-�'o+-3� �J�� �Cit ZIP: 5��3`�l yL�' <br /> Y� `l,?�}`'l�r�r�4 <br /> Contact Person: ^�,�� EZ,,����� Applicant is: ontrac� / Homeowner (Circle One) <br /> Email and/or Fax: rvd�aic.�,�� 57f�'�,�- q.�,src��q�s • C�� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �E;�,�2 C� ��69vbr������� <br /> Phone (day): �($�Z.-�ZZ"t - Z�,pl <br /> Address: �Zb�} '��a:r--,5 �,;�T 2v� City: (�2,C� ZIP: !��3`t/ <br /> Email and/or Fax LTp./�Gv� � (�,4(Li�j��r�i, L�,�.�'.('��.� <br /> ARCHITECT/ENGI ER INFORMATION: <br /> Name: �9�,4t-�►�1M �� F!'RP.�tI r'6F;�'tG�.- <br /> Phone (daY)� Zpl.,- ��Z.�-�"l�'1�Z. <br /> Address: �4�g /Z ry ��� City: �(�E �lU� ZIP: ���Z Z <br /> Email and/or Fax: 2�.-iT l� (o24E�1/a�i�G}P�•C'.�� <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 /> ��her: (specify) �'S ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> ""Any earth movement may require ❑ Commercial �Other(specify) <br /> MCWD review 8�permits. ❑ ndustrial ���5 ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ther: (SpeCify) <br /> 18202 Minnetonka Blvd �J�r�,q}-�� <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �� <br />