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" .' • '� <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: Q —�00� <br /> �,�,�. PO Box 66 <br /> � ^� O Crystal Bay, MN 55323-0066 Date received: L �� � <br /> � Received b ��' <br /> ,� � a, StreetAddress:' y� 2 <br /> '$2, � '`'� GtiE'' 2750 Kelley Parkway Plan review fee: � J , � <br /> LqkESKo4,'� Orono, MN 55356 <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: ��.��� G j<:�I-{f� ,�,h E-ftLL. ��'�� (",�{..,`�..!w:t.�� Yb1f� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? � Yes ❑ No <br /> lf 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-permifted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: C}��; Cu�� �� �,.�o,�. <br /> State License# Zo r 35q-'7�} Expiration Date: <br /> Phone: (�tZ- 333-8c��� (office) (�)��6��=i' M.. �,��`�:�> (cell) <br /> Mailing Address: /c��,y�f- '"<;�� �. � _�s� ��:,R, Cit : ZIP: <br /> Contact Person: Jo1�-�,.,a �nJr��. Applicant is: �tracto / Homeowner (Circle One) <br /> Email and/or Fax: .�)`�;,�r.sr;kr"'�,. ��"'�.�:�:'_�.�:: c'r{� �C��~�� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �;�'`�� �'�;,�`�'a::-;wr.�,,.: � <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: !f;'t,; s' �_.: ,r;�'.; �:;.7 �C <br /> Phone (day): • t ,.�..� �,-�, �"� 4 ,F,� ' <br /> Address: 'ti' �. :.:,, f E- �,.j �`�:;;; _f� x,.:.-�"1C ty: ZIP: <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 J�J Single Family with [`Z� 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 ,�]C Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Othe�: (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) $ f���j <br /> - 18- <br />