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� . , �lAl�� <br /> i�0�� •,� <br /> City of Orono �� � �a'� s� <br /> ��� �� <br /> Building Permit Application �' ���i�' <br /> for New Structures or Additions <br /> Mailing Address: - <br /> � PO Box 66 Permit numb�r.`� ��-i i `; , ( �_ . <br /> � �0 Crystal Bay, MN 55323-0066 Date received: � '' t� - <br /> StreetAddress:' - Received by: i�� � <br /> y� ,� 2750 Kelley Par�y �_ �_ � � ( , , ( �_). ! �;`� ;r`£ j/ �.�. <br /> � ,� ( , l C l�� Pl�n review fee: , <br /> c. Orono, MN 55356 <br /> `9kfSH0�� Main: 952-259-4600 ' Total Fee: � � � <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be subri�itted. <br /> Incomplete applications will be return�d. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: f -, (, r <br /> �' ��:: F�' ',�— � �L-1 ��' , � �j�" '�, � <br /> Will this be a Parade of Homes, Remodel Showcase Harme or other Display Home? ❑ Yes No <br /> If yes, a special event permit rs required with Police Department and City Cour�il 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/APPLICANT INFO M�4T N: A <br /> Name: _�G,�� ' _ � - � .:. � <br /> State License# fy �' Expiratian Date: <br /> Phone: cell f� 2 -3 ' 73y� �` office <br /> Mailing Address: ((`(03 , , �,., ` Cit : � , _ ZIP: _.�.�3�' <br /> Contact Person: � � Applicant is: Contract r / �Homeowner Circle One) <br /> Email and/or Fax: -� 't c�.i '" � .C'!� '-- <br /> PROPERTY OWNE INFQRMATIO�V'�✓ , I ,^(� <br /> Name: L'c- - �`.r;l� - P.� t7�', �f'SIKL'�' <br /> Phone (day): Z�.'�� t'Z �, �� �, . <br /> Address: � �" ° �•r� ', Cit : (�'�b�G; ZIP: -��� 1 <br /> Email and/or Fax � ' ��'��,� ,. 7, ;�� a�-f� .c�Otr <br /> � <br /> , <br /> ARCHITECT/ ENGII� !�INF RMAT ON• <br /> Name: � I�C�� ����" ' -�� <br /> �. <br /> Phone(day): - G ' • <br /> Address: �. �:�,ll ; Cit : ZIP: � � <br /> Email and/or Fax,�� , r �, c� �r� ?r •C <br /> PROJECT I ORMATION: Description of pro�ect: <br /> 1.Type Pr �ect 2. Proposed Use 3. Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ��Ne nstruction �Single Family with ❑Accessory Bldg./Garage � <br /> �❑A � on attached garage ❑ Deck �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage Residence ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo �Retaining Wall(s) <br /> ❑ Public 4-feet or greater Public Water <br /> ""Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review 8�permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) ❑ Other(SpeCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ (1�j �� <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />