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. <br /> City of Orono <br />• Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: ^ <br /> �Q A.O PO Box 66 Permit number: �-�C- ��G - O/ r� j <br /> `V Crystal Bay, MN 55323-0066 Date received: J<� l Z %�'' <br /> StreetAddress:' -} ft � Received�y�_______. �!-' <br /> /` I� �' "7�t � — --- <br /> yF ,� 2750 Kelley Park�y �� ��_��5�1 Plan reviewfee: � - > y� ` <br /> c,` Orono, MN 55356 _--= ----- <br /> - ---- -- -- __-- <br /> !q�t SH� 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 INFORMATIO� �� � <br /> Job Site Address: � i !`�".S����E�-� ���v� . �"v�� ��1 �`�� � � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> /f yes, a special event permit is required with Po/ice Department and City Council approval 60 days prior to the event. Shutt/e bus service wil/ <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT FORMATIO : J � <br /> Name: �Z �C�-� rS -- �L� �i� �Z <br /> State License# �� � Ex�iration Date: ��3�- <br /> Phone: cell �� � ��-- - office /J� � 7 - t <br /> Mailing Address: C'✓e vi.�w �/� Cit : CJ�rC�r�u ZIP: S (v <br /> Contact Person: /O n� Z Applicant is: Contractor / omeowner �(Circle One) <br /> Email and/or Fax: P Z L� � �ii c� ` 4 L� • C.c� <br />• PROPERTY OWNER INFO MATIC�N: � ��� � j� � <br /> Name: C'�`,"["t" �Ct-�-� <br /> Phone (day): !S� - �/ - / 933 <br /> Address: �� �� � T P '�1 /i•�Ptti/ vZ Cit : �YC�rc ZIP: .55:�.`J � <br /> mail nd/or Fax �rnr�: l � � � � -e �� C``� fr� cL h Co• �Z��-� <br /> ARCHITECT I ENGINEER INFORMATION: /� �,.�c / <br /> Name: c f`/ tiL�NS, � � � ` L /� .0 `�Cl � � ll C�f� <br /> Phone (day): `__�,� _ � 7 - /S <br /> Address: � c� • p v� . Cit : l���h� f�i�S�iLZIP: �� ��� <br /> Email and/or Fax: ry C' � / � Cc . <br /> PROJECT INFORMATION: Descri tion of ro�ect: ��! ��l��Yl ` -�G ��������'''�-- <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ lyew Construction ❑ Single Family with ❑Accessory Bldg. /Garage <br /> �Addition attached garage ❑ Deck f�Public Sewer <br /> ❑Accessory Building ,� Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage f�Residence ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> `*Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review 8�permits. ❑ Industrial ❑Warehouse [�f'rivate Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other (speCify) ❑ Other(speCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br />• Estimated Construction Valuation (excluding land) $ ��j��LN <br /> , <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />