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. <br /> City of Orono <br /> � Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: permit number: ZQ �� —� �� <br /> �Q A> PO Box 66 <br /> {VQ Crystal Bay,MN 55323-0066 Date received: 1 Z ��j <br /> StreetAddress:' ceived b : �/ <br /> y ,� 2750 Kelley Parkway , -1 ��o -Plan evie fee: 2 � 5�_ -t�] � <br /> F L Orono, MN 55356 � � <br /> `qkESHOQ'� Main: 952-249-4600 Tota 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: Z�j�j - �N L - O ZoNO <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 Po/ice Department and City Council approva/60 days prior to the event. Shutt/e bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events wil/not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: 0�2- �'iN lN�.. <br /> State License# C�P Expiration Date: - / - j <br /> Phone: (cell) r:�/2 . S�a . f�� (office) Gj f 2 �(�� . �}�1 <br /> Mailing Address: � • � - ��Z Ci : Z� Z�p� �0, S-S- _ <br /> Contact Person: " Applicant is: ntrac o / Homeowner (Circle One) <br /> Email and/or Fax: � � - � <br /> PROPERTY OWNER INFORMATION: <br /> Name: - p <br /> Phone(day): <br /> Address: �"i L Cit : bZeY�'O ZIP:,$� <br /> Email and/or Fax ►��..L�� 1 F�SCl�'�� < ���'� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �SK-J�N� 1��.`5l��� <br /> Phone (day): (Qt2 - ��- >�� <br /> Address: 7,�� L�'(1�� Si E S�/'7b Zf� City: �/�pL/�} ZIP: d's1JJ 5��/ <br /> Email and/or Fax: �-��'}-'iZ_ �=5�L �?�..N� �l�Z - o�J _�U•.,� <br /> PROJECT INFORMATION: Descri tion of pro'ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8 <br /> ❑ New Construction Water Supply <br /> ❑ Single Family with ❑Accessory Bldg./Garage <br /> �Addition attached garage ❑ Deck <br /> Accessory Building ❑ Sin le Famil with ❑ Public Sewer <br /> g y ❑Office/Commercial <br /> ❑ Relocation detached garage �tesidence �(Private Sewer <br /> ❑Other:(specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑Public Water <br /> "'My earth movement may require ❑Commercial ❑Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse � Private Well <br /> Minnehaha Creek Watershed District MCWD ( p fy) ❑Othe�(speCify) <br /> ( ) Other: s eci <br /> 15320 Minnetonka Blvd L7�`t1`7•L��"'� �j"�I��� <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 ��f n�� <br /> Fax: 952-471-0682 <br /> www.m innehahacreek.or <br /> � f1 �c�C_r�'_ �� <br /> Estimated Construction Valuation (excluding land) �f, <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />