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:, <br /> c <br /> � City of Orono <br /> �f� 1�, o �� . 75J <br /> Building Permit Application�o�,� , <br /> for New Structures or Additions � ' <br /> Mailing Address: Permit number: OC - �id$'� <br /> ���,�j.�\ PO Box 66 / /� <br /> Q x:` O Crystal Bay, MN 55323-0066 Date received: � � � � "! <br /> �, /�/J� <br /> �, SfreetAddress:' Received by: ��- . <br /> ,� ����,� �._: �'S/. F�9 <br /> � ��'� 2 7 5 0 K e l l e P a r k w a �� �� <br /> ,� : • �• ti <br /> � Y Y M 3 � lan review fee: <br /> ��9g� r�"��i� Orono, MN 55356 p q_ D0 <br /> �_ESHO;:: 02 <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: ZyDO Fox S'�P�c�'', D�tanJO� �IJ � 1'',5 3S� <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 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 allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Na me: �.'E S �. p � ��,. <br /> State License # 'Z,O(o'',�SZ.�{'� Expiration Date: 3 <br /> Phone: Lt2. 3'�3 . $OZO (office) (cell) <br /> Mailing Address: l�'OS'O S�'' Cit : (L. pU ZIP: $S <br /> Contact Person: a'aM,v �oN��-K Applicant is: ontracto� / Homeowner (Circle One) <br /> Email and/or Fax: ?_SOr.1rJ�K (�GHAn-4E�SG�t>�. GON�, <br /> a::• �;� � �\v� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��A.O '�' �u�.iF �..�N�81.00M <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: , ,1� - <br /> Name: CMM.LES �.onu ��.. F J�ltl �--L�. <br /> Phone (day): �(Z,"3 ',p <br /> Address: 1SOS0 23�• AuE City: �Yµ�J'1}t ZIP: �`�J�/`'��} <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> �$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) $ 3����`� _. i'" <br /> Last Updated: 9/29/2009 � `� <br /> - 17 - � � �; �:, <br /> ��i_� -771?� �� <br /> � i <br /> 1 <br />