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� City of Orono <br /> Building Permit Application <br /> ` for New Structures or Additions <br /> Mailing Address: Permit number: � U� — v"Z <br /> � � PO Box 66 <br /> � �� Crystal Bay, MN 55323-0066 Date received: <br /> Sfreet Address:' f� eceived by: _ <br /> � 2750 Kelley Parkway � a <br /> 9 �' �n�� ,P an review fee: <br /> �'t c.` Orono, MN 55356 (�+� . �,.� <br /> qkfSH��� Main: 952-249-4600 Total Fee: <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: �a�.� �(��/i/(,�- C�;�� �Q <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a specia/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 applrcant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: 'PL�"K kr�vpoL <br /> State License# COo t 7�l 7 Ex iration Date: <br /> Phone: cell 6'f -3a ~ office ��2--� <br /> Mailing Address: - � l� Cit : 7aru ZIP: �' <br /> Contact Person: �}N2c� -1,,/ � Applicant is: Contrac / Homeowner (Circle One) <br /> Email and/or Fax: Z�b a ken,�ui � CdN�t <br /> PROPERTY OWNER INFORMATION: <br /> Name: � QCO NC:7,L N L 11/NC � 1�}S/LI(,��5�.71/ <br /> Phone (day): �- - <br /> Address: S �C C K Cit : ZIP: <br /> Email and/or Fax ,�nt a�,,�, vv�/� Cp <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: ��L/'�"� ��CK �7N $C/I�� ��'�,huiC� Gret,��� <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction �Single Fa[nily with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with �Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence �Septic <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) ( ompliance certificate <br /> ❑ Public 4-feet or greater may be required) <br /> "'*Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Public Water <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (Specify) ❑ Other(SpeCify) <br /> 15320 Minnetonka Blvd;Minnetonka,MN 55345 �Private Well <br /> Phone: 952-471-0590 / Fax: 952-471-0682 <br /> www.minnehahacreek.org <br /> Estimated Construction Valuation (excluding land) $ o`��DOC� <br /> Packet Last Updated: January 2016 <br /> Page 21 <br />