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: _ _ _ --- <br /> _ _ ..-- <br /> REG��vE� <br /> U�C � � 2p14 <br /> GI'� �F �RONo �UiLDifiIC`� �� �RQ'��O <br /> E�f�1���F�PLf���'�C3t� <br /> FC�R �IEW STRI�CTC�RE� �R �,���T'�O�lS <br /> �� �f P�Rai/in�Address: <br /> �� �� , 2C�1 y -QI�{ �� � <br /> � ', PO Box 66 Permit number. <br /> Grystal Bay,tv1N 5,323-0666 - <br /> 1 Date received: <br /> \ ` �-�L-°��4—; <br /> •�l, 1 � \ i Slreel Rddress' -- � Rcceived by �� <br /> •. � .�,},� ,. 750 Kelley ParkvJa --i- - - ,. <br /> '.r�l�titic��` -` Oronc, l��N 55350 � �-��CL I P�an reviek�fee: � <br /> - ___ . �-,�q� _�.._��--,Zo��-�� <br /> , lviain: 952-249-460G Fax: 952-24g-46�6 �.��,; ,; �otal Fee ------- ��� <br /> ,._.ororo ir,�i.u� i <br /> This application form must be compiefed in fuil and all requfred infori��ation must be subrnifted. � <br /> inconzp���e ap���cations wiff be retumed. (Please prini) J <br /> GENERAL fNFORMATIOI�t: <br /> Job Site Address: - <br /> –11�—C1-1���;=—�-{,��_ �,1_ �t,'�.. <br /> Will fhis be a Parade of Hornes, Remodelers Showcase Home or other Display Home? <br /> �I tC`r_Z���I�G��.l���o__._ <br /> /f ycs �speaa!e:e;rd p;;mut is requireu t•rirh P�1;�o Depar.ment�,rd Crry Councd� rovar <br /> �eyu:red�nless�pp/;�;ir�;�crn,�nsirates sufl;cien!un-sdr,parkrng rs as'arlabla. Nun-peimitt�d evcnts will nui be alJowed. � YeS <br /> PA 6U days pnor fo the event Sruftie bus se:rice r��b vc <br /> CQNTRqCTOR/APPLICANT aNFORMATIaN: <br /> Name� ',�!, ' , / <br /> �C"(-�"-l�-F--h�S��=5_��f �JJ L d;7 <br /> StaieLicense# ��_�����,.- - �- _1�C_._` <br /> ___.�_--- <br /> - - - -__— --- ---- <br /> hone: cell ty-2���„t>,_� Expiration Date: 3 �--� <br /> �4ailin Address: __-�--- office' --,�L-Z�,�r <br /> g �' i� -'�_= __�_�1__ -____.. <br /> Contact Person: ��- ------- City� <br /> ��rt�..1 -_-- - l���.t`._��fvi�ZIP: �u�� <br /> Email and/or Fax: App�icant is: f' --� , <br /> �*�a`����''��C'�2�Lc�,1�-'1��,( ,�-1���_ ontr cl Homaowner (Ctrcfo One) <br /> -F�=ks---7_-�2-�--ss=`�2-`�LZ--- <br /> PROPERTY OWNER INFORMATiON: <br /> Name <br /> Phone(day): �t��� ��"�" _ <br /> �---�- --�_.___ <br /> Aadress: w' , -�== '� ,- t __ --------_-.-- _-__-- <br /> Email and/or Fax �L`-f_��'�____C�}�.5�=-��� � W/f''.��'�'tT!t _�_! <br /> _ ___ Cit��1(�t"�; 21P: C <br /> _-- --- --��-�-J-/_ <br /> ARCNIT�CT/ENGINEER IN�ORMATION- '--_—'-_ � - <br /> i�,'ame: <br /> Phone(day): _ _ ------ -- - __ <br /> Address: - ---- _. ��— - --- _ <br /> Emaii and/or Fax: i'! �! _ C�•ly: ZIP: <br /> __------_ --- <br /> PROJECT INFORMATION: Description of pro�ect �i � <br /> i^1.Typc of Project � <br /> -�2. Proposed tJse 3.Structure Type "'-"""'-"""II^~~��--------�- <br /> 4. Sewage Qisposal& l <br /> ❑New Construclion I �n�le Famify wifh I �ater Supply <br /> �Addition �tResidence j <br /> I Accessory Building attached garage u Garage i Accessor��Bld ; � <br /> ' ❑Relocation ❑ Single Famiiy with ❑Deck ' 9' � ❑Public Sewer 1 <br /> � ❑Other.(saecity} � detached garac�e ❑O�frc�/Comrnercial I <br /> : ❑f,'luliiple Fami�y/Condo , ❑W��Ei�ouse ��'n�'at�Se•r.er <br /> I "Any earth movement may aisa re uire � ��ubtic ' ❑Storage � <br /> I MCWD review 8�permits. � ❑Commerciai ❑Other(specf(y) ❑ public VVater � <br /> ❑Industrial ' <br /> � Minnehaha Creek Watersl�eo Distric*.{MCWpj I <br /> � 18202 Mionetonka Bivd ❑Olher.(specify) ❑Private Weil <br /> � Deephaven,MN 5539� � � <br /> Phonc: 952-477-0�9G � <br /> � Fa;c 952-471-0682 , I <br /> `�.,_=:�,.m�nnenahac:a�,k:GYr�-- _._1._ + <br /> I <br /> - . -------- ____'�v�-- I � <br /> Estimated Construction Valuation (excludii;g land) s ys u.7 . �' <br /> �---/-_- _�._ _ <br />