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« <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> ���� Mailing Address: <br /> �.,�,j� Permit number. Z�%« - - "� <br /> PO Box 66 L`'�� <br /> � �� Q Crystal Bay, MN 55323-0066 Date received: (.,o / I U � <br /> ��:�,� <br /> �>�� <br /> � 1��� `� � StreetAddress:' Received by: �1� <br /> '�'�'��'r��.� �� 2750 Kelley Parkway �3 <br /> �' lan review fee: <br /> `�fcEs�o�� Orono,MN 55356 �'Y�`; L ,�� <br /> � Total Fee: �� C K" <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 retum�d. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �� � �� , � G-t k'1� f` Gx�A_ <br /> Will this be a Parade of homes, Kemodelers Showcase Home or other Dis pla y Home? ❑ Ye s � N o <br /> lf y e s,a s p e c i a l e v e n t p e r m i t i s r e q u i r e d w i f h P o l i c e Depa�tmen t and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required un/ess applicant demonslrates su�cient on-site pa�king is avaifable. Non-permitted events will not be a/lowed. <br /> CONTRACTOR/APPLICANT INFORMA�I�N: <br /> Name: _ �-�-�. E�'�e`� eiff�� -L�.�►C <br /> State License# Expiration Date: <br /> Phone: f�(s�.� _=��, -� .-�>� office <br /> Mailing Address: ' a _ �i� ���'���'2 5��r� cell <br /> =� Cit : -x ;[_ j ZIP: S �2�' <br /> Contact Person: ;iY��� i c.l�,r l S , Applicant is ntracto / Homeowner <br /> (Circle One) <br /> Email and/or Fax: �-r7;.j� � �l� � - ° �, <br /> �2 - "�� 1 • � <br /> PROPERTY OWNER INFORMATION: <br /> Name: �! i , d � . ` ` ( � ` <br /> Phone(day): s� �- ` �-( � �Z`�gf� <br /> Address: � S � . ��.z c!�-�.._ /�� Cit :v � � ZIP: � `� i! <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: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal& <br /> ❑ New Construction Water Supply <br /> ❑Single Family with ❑ Residence <br /> ❑Addition attached garage ❑Gara e/Accesso Bld <br /> ❑Accessory Building g rY 9• ❑ Public Sewer <br /> [] Relocation , ❑ Single Family with ❑ Deck <br /> [�Other.(specify) �1 � + ' detached garage ❑ Office/Commercial <br /> ❑ Private Sewer <br /> `����.� ❑ Multiple Family/Condo ❑Warehouse <br /> � ❑ Public ❑Stora e <br /> '`*Any earth movement ma re uire 9 ❑ Public Water <br /> Y q ❑Commercial 0 Other(specify) <br /> MCWD review&permits. ❑ Industnal S .; ���..;,i��•� ���� � private Well <br /> Minnehaha Creek Watershed District(MCWD) �Other.(speCify) <br /> 18202 Minnetonka Blvd �- <br /> Deephaven,MN 55391 ��'` ' � � �+3 "'� <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation(excluding land) $ ���`� ��-,�r ��_ <br /> Last Updated: 5/21/2009 <br /> -20- <br />