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c� �,��' _ <br /> ' �-iz"'3 �� � <br /> . P¢'d . <br /> . ' � � <br /> , City of Orono � �J� <br /> Building Permit Application / <br /> for New Structures or Additions <br /> ,.._— Mailing Address: � <br /> ' g,�,j�.�� PO Box 66 <br /> Permit number: a0�3 ' � <br /> i <br /> �%0 Q\� Crystal Bay, MN 55323-0066 Date received: ��.- � <br /> �k ' � <br /> �a ''"jl� ,, ,� Street Address:� Received by: <br /> �`f ��'_.� �; � <br /> �� � �ti 2750 Kelley Parkway Plan review fee: � / <br /> \\�t9kE9H�4�'� Orono, MN 55356 �v _�� <br /> �--_- ` Total Fee: � <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono-mn_us r� <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: c! :" F r , r;:.-� }:,.ti' ' IJ �i ��`�� � j� , �'�//�/ �S�`" <br /> Will this be a Parade of Homes, Remodelers Showcase Horrie or other Display Home? ❑ Yes No <br /> If yes, a special event permit is required with Police Department and Ciry Council approva160 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrafes sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> l'� !111ti� <br /> Name: r;�:-,, c" ��G�Ir•' <br /> State License# (3C', ,7�y�= 42�� Expiration Date: � � s <br /> Phone: office ' �Z 2�3� 3' cell <br /> Mailing Address: �"(� 2�l t�1 lIVL% N�-V City: � ZIP: �'�SC�`�1.b <br /> Contact Person: ,C �4- 5�� Applicant is ��Contract / Homeowner (Circle One) <br /> Email and/or Fax: ,j (�lCL���'� L IN�1J�= �N -: �.p�*-� <br /> PROPERTY OWNER INFORMATION: <br /> Name: (' <br /> ` ;. <br /> Phone (day): /, � �r�_ �"� :. �.—,, --, <br /> Address: �..q v XAN-TNO� L�.�<�;' ✓�i City:PL`�n�/D,;/T=+'�� ZIP: _, ::: ~�==� � <br /> Email and/or Fax —�'�:.,�t._'r'i'-; �!ryfLJ/;� . (��:' <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: .«.; <br /> Phone(day): <br /> Address: /" �;, ;: , � : . City: , ZIP: � -/ <br /> Email and/or Fax: _ ' ;f�- ; <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8� <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.min nehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ �� / , <�(7U <br />