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~ City of Orono 2� ��� <br /> � � �� <br /> Buiidin Permi � <br /> g t Application <br /> for New Structures or Additions <br /> /�O�� Mailing Address: Permit number. oZ01� '" ��9�f <br /> y_ PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 9 ��`�Z <br /> �^�, <br /> ��"�`�:� Received b �fC <br /> .� � ` �. Sfreet Address:' Y� J <br /> 's�'-.�_ <br /> �� y y� titi 2750 Kelle Parkwa a0/a`�09D� <br /> � o y Y Plan review fee: <br /> L�sgE���o4� Orono, MN 55356 /365• 5�9' �e(� <br /> � Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.o r o n o.m n.u s L S Q,��f�(: , L <br /> This application form must be completed in full and all required information must be submittedyl,.,Zbb Lp�L-l�(�Q�5�j <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �j�j�jS �c>[,.�?✓d�/�?i� C'Gc/�% �,�jtf�'� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> !f 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 INFORMAT,ION: / <br /> Name: YD U�F�►'�e'L-O 1f0 M� �' <br /> State License# _�jC(c�a,�6%O Expiration Date: 3-3f-/3 <br /> Phone: qSa-�(oq�40�n(p (office <br /> ) C�(a-- �-�7- �3?v (cel�) <br /> Mailing Address: 222(�d � � (..., �. Cit : Lf}� � (I L ZIP: SSac.F <br /> Contact Person: �'O�`f� Nu�-1..��2 Applicant is: ontrac or / Homeowner (Circle One) <br /> Email and/or Fax: �}�($'ad�ey-beck;..Q�;���r.�-� h�,{- <br /> PROPERTY OWNER INFORMATION: <br /> N a m e: �(�' �Z /Vl,�"L i sS�q ��-�L nl i c=�2 <br /> Phone (day): �$/- �y3_79ii <br /> Address: 5'�f IS/Lt�,q�pw� /�v� ,�!. City: L✓A�Z,¢�j�} ziP: SS3�/ <br /> Email and/or Fax Sfi-etf� bczrn�i Po" �f� f7oriv14�/ caM <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP• <br /> Email andlor 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) $ o�rl 3 0 �S� <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />