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.. -. <br /> Building Pe�mit AppliCatlon M�t���t�� <br /> � DENIED <br /> City of Orono <br /> �. <br /> Reason(s),tor denial: �`�� ti`������-�����C��-' <br /> Building Permit Annl�cat�on <br /> for New Structures o ' ' , ; :��� <br /> �_ Mailing Address: a � ermi num er: a � � �. 4'.�` <br /> /% � � PO Box 66 <br /> %� � � �� Crystal Bay, MN 55323-0066 Date received: � f�/,',- " �.. `�' <br /> �/ � y � \1 "'V <br /> ' Received b �� ► " <br /> ` '� Street Address:' <br /> Y - --' <br /> !',a 1'���,�_;` ''�/ ; <br /> "'� ��i. �� ti 2750 Kelley Parkway � r P1an review fee: � �� �a.`�`� <br /> ���t ''�����v°� Orono, MN 55356 � l��13 � <br /> �9g s�H� <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: ;�]CI(%° �%Ti�/CL �v'C� <br /> WII this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes (�fo <br /> If yes, a specia/event permit is required with Police Department and City Council approva160 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 a/lowed. <br /> CONTRACTOR/APPLICANT INFORMAT�ON: <br /> Name: �f'Ji�/Vl�iL' ,�1'���'/77'�'..S LG ' <br /> State License# �p � �;%y/(� Expiration Date: 3-��Oi�.� <br /> Phone: �.y12-L�IG,- yy y 7 (office) (ceLl�-- <br /> Mailing Address: �j y5 !5 3� �'/<;�,� City: ,s��{,,tJ4� ZIP: ,SS„� 1� <br /> Contact Person: _ i��c' Y�;c'rints�� Applicant is: ��� Homeowner �c���ie o�e� <br /> Email and/or Fax: QS;,7- ys"j�3-�- ;�fJ�4� <br /> PROPERTY OWNER INFORMATION/•� / <br /> Name: �-C��':� (�/l C'/".Ar 1� <br /> Phone (day): _���.� -(� ?d " y?_Z� <br /> Address: /Oi�J C�� ' /v�.✓ V��s.� �r�v�'' CitY: ��'v/�c;> ZIP: .S�S-.�S`�, <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFO ATION: <br /> Name: <br /> Phone(day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project Z. 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 /> ❑ 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.minnehahacreek or <br /> Estimated Construction Valuation (excluding land) $ l0{ OC�iC� <br /> Last Updated: 6/22/2009 <br /> - 19- <br />