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� � - g .��R���iv�� <br /> � �, �1 <br /> City of Orono � OCT 1 82016 <br /> Building Permit Application CITYOFORONO <br /> for New Structures or Additions <br /> _---�.� Mailing Address Permit number: o?('� ' ��30 <br /> /��(�A,� PO Box 66 <br /> � `V Crystal Bay, MN 55323-0066 Date received: /D-! �/ <br /> � Street Address:' Received by: <br /> 2750 Kelle Parkwa <br /> S�, � y y Plan review fee: �4�,�,d 9 <br /> �{� ��t, Orono, MN 55356 �� _ b��� <br /> �x�s�o Main: 952-249-4600 Total F ��1 <br /> Fax: 952-249-4616 www.ci.orono.mnus cv�a.�/(o' b/,_3a, � <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: ',1 <br /> Job Site Address: � � ^�' � � VUZ`? rv�/� ���l� <br /> Will this be a Parade of Homes, Remodelers owcase 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/APPLICANT INFORMATION: <br /> Name: I� y �� �'�,�; --- Z�'l%�- <br /> State License# $G- I 'l 5„3 Expiration Date: ,�/ c�l 7 <br /> Phone: (cell) (�j � ,-"�' / office <br /> ��-��1 c > ��—y��,--a���� <br /> MailingAddress: � �1� Cit : a" 1f/gNGX.� ZIP: 5rj`.' � <br /> Contact Person: '�;+� �3i�, Applicant is: on racto � / Homeowner (Circle One) <br /> Email and/or Fax: �'"cw,�-{;� 1�.E5 [`'j�k�ry�n,���,Gc;,i,i,1 �5�.-y 7�,- �(o��2 <br /> PROPERTY OWNER INFORMATION: <br /> Name: �19�►� �3iC��(� <br /> Phone (day): jal�']/�-/(�? J <br /> Address: �'��Q /-'`rq-��,rr�rrf> �� � City: P-��c�+°�.'U ZIP: J�-5�,3�� <br /> Email and/or Fax (�:-y��L'� ,nn.��Cd� �TyVtr•1-i, , t_r.;i..t•� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: ��4Tb�u'�nf� ��-L�G��Z <br /> Phone (daY)� ��� -Sf7.3-�''�� .7 <br /> Address: �q� ��� L�, g;- City: d'���y7��y}- ZIP: ��� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro�ect: <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 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&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 /> ��x: 952-471-0682 I <br /> www.minnehahacreek.or <br /> „�stimated Construction Valuation (excluding land) $ ��'�d���� <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />