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. <br /> � ' City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> �� Mailing Address: Permit number: aQ -DD�33 <br /> ,%�v�,��. PO Box 66 <br /> \ Crystal Bay, MN 55323-0066 Date received: J�' s <br /> `\ <br /> i0 � O , <br /> ���R�. <br /> � �, Received by: �T <br /> \.� �A�. s.J Street Address:� <br /> �'� ' °°' � ��% 2750 Kelley Parkway � Plan review fee: a D I oZ . � ! <� <br /> �`�kEsxoti`%� Orono, MN 55356 � <br /> aoo9-o�s� 34 � <br /> Total Fee: /�QR <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us "� b" <br /> This appfication form must be completed in full and all required information must be submitted. <br /> Incompiete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �y�/ �ay;�,.,Qs Pa;-,,. }� �vE:.� � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [�No <br /> If yes, a specia!event permit is required with Police Department and City Council approval 60 days prror to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted evenfs wil/not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ✓vt��ltia-e�� Cz� (�u 5 ��s� �T c <br /> State License# a�o�,j 5 5-� Expiration Date: � �i-a,�.� <br /> Phone: 7.� 7-- �7 z-z i 3 i (office) ��2 - 7c 9 -- 9�y E (cell) <br /> Maifing Address: � 3 0� �i� ,¢. Cit : �4 ZIP: s s� 3 i� <br /> Contact Person: '��.,, C-� (1� s Applicant is: ontracto / Homeowner (Circle One) <br /> Email and/or Fax: d- -�a (l� s �y-,��r; _ �o�-.-� <br /> PROPERTY OWNER INFORMATION: <br /> Name: i^�1,�< rt- �.���� c�.> k--,:-� � � <br /> Phone(day): 9 S z - 2�o - a 3 z,S <br /> Address: /4 Y! ��,�.,r..� s �z,r �. �2,�,�- � City: U°�-�<� � ZIP: <br /> Email and/or Fax ' <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: � c„ s���,� t-�s �� k S <br /> Phone(day): �� 3 � a-a y - "3 �S g <br /> Address: � a a �c,,2e f�. s �r.�,�....� Clty: f.�.,)c«.-en �.� ZIP: S-S .3") G <br /> Email and/or Fax: <br /> PROJECT INFORMATtON: <br /> 1. Type of Project 2. Proposed Use ' 3. Structure Type I 4. Sewage disposal & <br /> i <br /> Water Supply <br /> �'New Construction j �Single Family with �Residence ', <br /> ❑ Addition �I attached garage I ❑ Garage/Accessory Bldg. i � Public Sewer � <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation � detached garage ❑ Office/Commercial I ❑ Private Sewer <br /> ❑ Other. (specify) � ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public � ❑ Storage [�Pubfic Water <br /> *''Any earth movement may require ! ❑ Commercial ❑ Other(specify) <br /> MCWD review 8� 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 (excfuding land) � ��U;D 6 � <br /> - i£ - <br />