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1 � <br /> sr-� � ( � � <br /> -�e�"�'� �� � ''C • <br /> City of Orono � � (�� <br /> J/ <br /> Building Permit ication <br /> for New Stru res or Additions <br /> ,.-- Mailing Add s: Permit number. � [� �/ - (�;��(r� <br /> .¢,���� P ox 66 <br /> O Q� rystal Bay, MN 55323-0066 Date received: <br /> �� <br /> `����.�: Received by: <br /> a. �+a t� �, Street Address:� <br /> � ':�- �_ , � � <br /> 's' � �� ti 750 Kelle Parkwa � ( — jbL�� _ <br /> � '� , ����o��- 3 �a�� Y Y � L IL� ��' Ptan review fee: Z�-� �' <br /> t � ��` sv rono, MN 55356 � <br /> 9kESH�4� <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: . 3�t7 ��-�c �;2��-�. u�c;�.,,::; M;�7 . �5�:�to <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 e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: g��.+a c� �- i�:u�';i;;..n�A�.h <br /> State License# 3 7 2. Expiration Date: :� �3I 2v, <br /> Phone: �j��.) :{-i 3•- Sy •3� (office) L 6 i�.,) H��( •-5��3 (cell) <br /> Mailing Address: M.aEv�' J��A �.va- Cit : �ZhT�� ZIP: �•�,•� <br /> Contact Person: �;�. �;�Mi�SG=L��R� Applicant is: ontracto / Homeowner (CircleOne) <br /> Email and/or Fax: �.`� =,;-z;,,.i✓�r�;:�,1,•,�,�;�� .;_c,�„� <br /> �-- <br /> PROPERTY OWNER INFORMATION: <br /> Name: �i�7�ai,Y t�3tit.;is <br /> Phone (day): ��;�) •7u. •- ioE��� <br /> Address: ''�3�v �ux �i�t�'��T City: f.�urav ZIP: �+��{�, <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: �ES,c��-3�c c�S��rrv� ��r��f' � r'�r�2 �3�cv:=+�� � <br /> Phone(day): (�,•il 247� - '7�7� <br /> Address: ���� M'NrV��'L�J►L� 8:-v�• City: �Ayz�'�Q ZIP: yy�y � <br /> Email and/or Fax: ��,��z�, (� {-;,,,,��tcs7� r�.1,.;-r�1- ' a .�► <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) $ �,•{�i f y��o,��;u <br /> Last Updated: 4/26/2011 <br /> - 19 - <br />