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� � � ' <br /> I � <br /> �I <br /> City of Orono ��� <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: l.S� <br /> � �� PO Box 66 <br /> Q Crystal Bay, MN 55323-0066 Date received: �� '(D ' ��j <br /> StreetAddress:' Received by: <br /> ~' ,� 2750 Kelley Parkway � g <br /> y� �` Orono, MN 55356 Plan review fee: <br /> `qkfSHO�� Main: 952-249-4600 Total Fee: ����� "'d��� <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 submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 315f� ti5cn �kc.l� oc'ots � <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 �ll be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be a//owed. <br /> CONTRACTOR 1 APPLICANT INFORMATION: <br /> Name: 5-�'c,�,a�oL , ��� <br /> State License# 'rj� So(c�3 I g' Expiration Date: �2_ �d <br /> Phone: (cell) (.,�Z- Z.�o� - 2�?0 (office) 61 Z-�f bt-�-10 0� <br /> Mailing Address: � L�tc„ -� Cit : ZIP: S <br /> Contact Person: 5�,� (�K�Sr,J Applicant is: ntra to / Homeowner (CircleOne) <br /> Email and/or Fax: S�{a p S{-c,.�.,,�o.L •t a•— <br /> PROPERTY OWNER INFORMATION: <br /> Name: ,,,�� I �/"4F� <br /> Phone (day): �' - S�t'S_ r�cr$o <br /> Address: �Sf �Z Cit : � ZIP: s5y?� <br /> Email and/or Fax r . �, <br /> �elgo�' �, C�rv� J�i+�.��.,� ��;, :,_� �; � ����t�� � <br /> ARCHITECT/ENGINEER INFORMATION: . <br /> Name: �, E �o `' <br /> Phone (day): q 2- �7-r <br /> Address: �o� �. �,K�.� 5� City: �,,�,.y,t�{'•ti ZIP:ljS3°l1 <br /> Email and/or Fax: �,r{�,y� � �}L�c�,,,J,s �p�;�„d (.� n, r�,..� <br /> PROJECT INFORMATION: Descri tion of ro�ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8� <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 detached garage Residence ❑ Private Sewer <br /> ❑Other: (specify) ❑ 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 ❑ 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 /> Estimated Construction Valuation (excluding land) $ ���oa � � <br /> Packet Last Updated.� August 2015 <br /> Page 21 � <br /> I <br />