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� <br /> VY <br /> . ,�.1 � � � `� <br /> / � <br /> City of Orono <br /> B i i � . �-� <br /> u Id ng Permit Application � 7�`�`t' <br /> for New Structures or Additions <br /> — Mailing Address: � _D <br /> � PO Box 66 Permit number: <br /> �� ��`� <br /> �Q Q�, Crystal Bay, MN 55323-0066 Date received: � <br /> 3 � � <br /> ����.� ���°r�r '�. s,;�' StreetAddress:� Received by: <br /> �'�n �i��� G�/� 2750 Kelley Parkway Plan review fee: / 7 .� /b BJr�-' <br /> tRkESH�4� Orono, MN 55356 a ��_ �v� <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: - ��_� , ;,� 1 , �' l;�' <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 approva160 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 al/owed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: •�- � �,.� , � 1 t ( � <br /> State License# >�;�,��y���; Expiration Date: � / -;�� _ , i �. <br /> Phone: (�'t 5 2) (.`l�•`i�i'i G (office) (cell) <br /> Mailing Address: �-�� Cit : ��-,�-. ZIP: �� - � �; <br /> Contact Person: ,,,;�i1 �,`,5�.,�.,�,,.� Applicant is: ontr ctor; / Homeowner (Circle One) <br /> Email and/or Fax: ._,,r- L . � _ I i, , . <br /> ---- <br /> PROPERTY OWNER INFORMATION: <br /> Name: ._ _l "_ t_ .,_. <br /> Phone (day): <br /> Address: ;` �:.��,�-. li, �. �� .1 City: � ZIP: '>� ' t <br /> >; >l <br /> Email and/or Fax �, _; ;' �, _ ..� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: /�j,.: , I.. r k,r.:� <�:; �:, <br /> Phone (day): � ; -�:�777 „ <br /> Address: ����_.� ' �r_���� Lt,I-.c `�F. Ciry: �lx;y���j-r ZIP: �; �, j `� � <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 �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 <br /> ❑ Other: s eci [�Private Sewer <br /> ( p fy) ❑ 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) $ � ,_� �,` �� <br /> Last Updated: 12/21/2010 <br /> - 19- <br />