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, � (��`�� '� <br /> -�/ City of Orono � �l 9 �, �� <br /> C�'��� � , <br /> Bu�lding Permit Appiication <br /> for New Structures or Additions <br /> Mailing Address: Permit number: � '�� � <br /> j�.,�,�. PO Box 66 <br /> � Crystal Bay, MN 55323-0066 Date received: o / � /o�, <br /> �( ;�.,;, <br /> �I �; � Received by: <br /> `a �3�-�.= a,�, Street Address:� <br /> \\ ;� ,.`�i 2750 Kelley Parkway Plan review fee: a 7/ . � <br /> l '�, ��� �� <br /> qA�SH�g Orono, MN 55356 <br /> �______ , p'�D/�-UO/��' <br /> �--- Total Fee: <br /> Main: 952-249-4600 Fax: 952-249�}616 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: .�`�L 4 ���, �LC' _C <br /> Will this be a Parade of Homes, Remodelers Sho case Home or other Display Home? Yes ❑ No <br /> If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required un/ess applicant demonstrates su�cient on-site parking is available. Non-permitted events wrll not be a/lowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �' C. .� 1�;� <br /> State License# C. J 3 7 � � Expiration Date: �3 3i /, <br /> Phone: - �t2`"—j � office - 7�Li� y - ` , cell <br /> Mailing Address: i�t � - � Cit : ZIP: 5�' T <br /> Contact Person: f4 ' Applicant is: Contrac or ' Homeowner (Circle One) <br /> Email and/or Fax: , p.� � <br /> PROPERTY OWNER INFORMATIQ�1: <br /> Name: ������ !�t��rl,��t-� <br /> Phone(day): l���_ r,,.7(� - C y S� <br /> Address: Cit : ZIP: <br /> Email and/or Fax '�,�.j,y-ir�� , r", L�fJ �l , �'['��t,t <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: t-� ? !L�% Nl�ll"6UG (�'i,�•�.IJ �,�' j L � <br /> Phone(day): 3 - ? � — " �� <br /> Address: ��C�� t�c�l,fZVKCr^v �1 /�� `�(G(� CitY: ���-�!� ZIP: �j'�j��-� <br /> Email and/or Fax: _��,�� � .����T�� <br /> �--v-� <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 ❑ Private Sewer <br /> -1 Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage �(Public Water <br /> earth movement may require ❑ Commercial ❑Other(specify) <br /> �eview 8�pertnits. ❑ Industrial ❑ Private Well <br /> �reek Watershed District(MCWD) ❑ Other: (SpeCify) <br /> �nka Blvd <br /> 55391 <br /> 5g0 <br /> �rc <br /> �n Valuation (excluding land) $ j�� Cj �j, `7`�('i <br />