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. > <br /> � . . . City of Orono � .� ,q� <br /> Buildin Permit A �ication .�. $r <br /> 9 pp . Y� <br /> for New Structures or Additions <br /> Mailing Address: Permit number: -•'� �' O \� <br /> �Q A> PO Box 66 � � . <br /> `w0 Crystal Bay, MN 55323-00 n $' Date received: • - -� <br /> StreetAddress:' ,�� _ __ Received by:_ __ _____________ � <br /> 2750 Kelle Parkwa ��G' � �,�W �G • ` <br /> y�' �� Orono, MN 55356 y � ��,� lan revie�"ir'fe : , ' <br /> - , ---- __ _--- _: <br /> t9kESH04� Main: 952-249-4600 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 submit ed. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: z�{ 8('' (.,�g�p �o►n� Rd . <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> If yes,a special event permit is required with Police Department and City Council 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 I APPLICANT INFORMATION: <br /> Name: ASP�N IaU1LDF�QS � /Z��eo FI.EkS /l1lG• <br /> State License# j�(; QSl,[Lf 8'�6 Expiration Date: 3•��—20t� <br /> Phone: cell � p- office 2. $dp <br /> Mailing Address: SQ/ (�lA�.SHlA1G ON O Cit : � ZIP: 5 <br /> Contact Person: �O� L1`/ Z. Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: �or 1 n s Pe h 5 L+.owrooru• c,o wl <br /> PROPERTY OWNER INFORMATION: <br /> Name: 5 e he h � 1� <br /> Phone (day): � _ <br /> Address: 2 Cit : �q,,� ZIP: <br /> Email and/or Fax S GYQ, ru do l e�rt U Q(ne0. t,4 r'►1 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> �� -I�, ► ' ►'�j'X�!���' ��� �x�36 --f-� �[� �.,�-Q- <br /> PROJECT INFORMATION: Description of project: - <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction �Single Family with �Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ❑ Public Sewer <br /> �Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> Relocation L detached garage ❑ Residence ❑ Private Sewer <br /> Other: (specify) �OQ�T �[Lu. ❑ 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 <br /> ❑ 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 /> /�� � <br /> Estimated Construction Valuation (excluding land) $ �5•c.(JlJ,— <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />