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<br /> City of Orono
<br /> Building Permit Application
<br /> for New Structures or Additions
<br /> Mailing Address: Permit number: ��7 — U�/�
<br /> Q�O�` CrysBtal Bay, MN 55323-0066 Date received: 'rj� � 09
<br /> ��' �' Received b Z
<br /> (,� �'�� �,�� StreetAddress:� Y' ,.
<br /> � '�t` � , i
<br /> 'S',E, ���IF ,,^ G~ 2750 Kelley Parkway Plan review fee: ��, j�C,>�
<br /> l �,"�C4��-`*'v Orono, MN 55356 (
<br /> ESH�4 }
<br /> - - - Total Fee: ,���"r // / (� /
<br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us `� �y
<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: .--���u �
<br /> Job Site Address: -�i� � � V� � fVi c in� ��/�_
<br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o
<br /> /f yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service wi e
<br /> required unless applicant st(ates su�cient on-site parking is available. Non-permitted events will not be allowed.
<br /> CONTRACTOR/ PPLICAN,T 1NFORMATION•
<br /> Name: -----' S�'�� �"�C�1��Cc��9 �
<br /> State License# � Expiration Date: --
<br /> Phone: r a - y �3 -i y�' (office) (cell)
<br /> MailingAddress: � C',-�S��,v;;,., �. City: C� /8nv __.ZIP: SS..SSk�
<br /> Contact Person: S�C urtl z;C Y1��:,;�1 �' Applicant is: Contractor / Homeowne j (Circle One)
<br /> Email and/or Fax: -----
<br /> PROPERTY OWNER INFORMATION:
<br /> Name: j/EYV1 C V�� Vl �U�C
<br /> Phone (day):
<br /> Address: City: ZIP:
<br /> Email and/or Fax
<br /> ARCHITECT/ENGINEER INFORM ION:
<br /> Name: 5 c�^(`�c�� � J�.� � `/�c' �
<br /> Phone(day): �,� �;,,,�. '
<br /> Address: �-{�i,�,� City: ZIP:
<br /> Email and/or Fax: �
<br /> PROJECT INFORMATION:
<br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal&
<br /> Water Supply
<br /> �ew Construction ❑ Single Family with ❑ Residence
<br /> ❑Addition attached garage j�arage/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: (Sp2Cify)
<br /> 18202 Minnetonka Blvd
<br /> Deephaven,MN 55391
<br /> Phone: 9�2-471-0590 ` 0�w�
<br /> Fax: 952-471-0682 � ��
<br /> www.minnehahacreek.or ,� +
<br /> Estimated Construction Valuation (excluding land) �,'� $ ''� „�
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