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, ,� E �J'"� �/� 1_' � <br /> t v �r�-� <br /> REC`IVED <br /> �` City of Orono JUN 14 2012 <br /> � �� Buildin Permit A lication <br /> _ � g pp CITY OF ORONO <br /> for New Structures or Additions <br /> Mailing Address: Permit number: o`Z L'I a - ,� 7 <br /> �,�,�. PO Box 66 e-�%g t�-��-�„� <br /> o �., o <br /> Crystal Bay, MN 55323-0066 Date received:r2,e,u.� �-i� i� <br /> �'"`` �. -f� Received by: L-C <br /> ,;`;;�, �, StneetAddress:' �p--� <br /> `�, � F' (,t;f/� i-i-7-i Z �vai `7 . 5 <br /> ,�., Gti 2750 Kelley Parkway _��� plan review fee: , � <br /> '�.�x� Orono, MN 55356 na H � <br /> Total Fee: Jh <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �(/ <br /> This application fonn must be completed in full and all required information m be subm ed <br /> Incomplete apptications will be returned. (Please print) <br /> GENERAL INFORMATION: : �� � � <br /> Job Site Address: <br /> Will this be a Parade of Homes, Remodelers Sho se Home or other Display Home? Yes o <br /> li yes,a speaal event permit is required with Police Department and City Counal approval 60 days prior tr�the event. Shuttle bus service will be <br /> required unfess applicant demonstretes sufficient on-site parkir►g is availab/e. Nonyoermitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: r � ; i^ �' <br /> State License# Expiration Date: (`'1�r <br /> Phone: 2 Z ' I office cell <br /> Mailing Address: ��f M� Ci : ZIP: <br /> Contact Person: r;c� �v c 'b5�v., Applicant is: ontrac / Homeowner �ci►cie ona� <br /> Email and/or Fax: <br /> PROPERTY OWNER INFO��T(ON: <br /> Name: �,N. �e <br /> Phone(day): <br /> Address: City: ZIP: <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.Struature Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction �ingle Family with ❑Residence <br /> ❑Addition attached garage ❑Garage/Accessory Bldg. ❑Public Sewer <br /> ❑Accessory Building ❑ Single Family with � k <br /> ❑ Relocation detached garage ❑Office/Commercial ❑Pnvate Sewer <br /> her: (specify) _��� ❑Mul6ple Family/Condo ❑Warehouse <br /> ❑Public ❑Storage ❑Public Water <br /> *"Any earth movement may require ❑Commeraal ❑Other(speafy) <br /> MCWD review&permits. ❑Industrial ❑Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Othe�: (SpeCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> .minneh <br /> ,�— ��=�. <br /> Estimated Construction Valuation (excluding land) $ � ����� � <br /> Packet Last Updated: 03-06-2012 ( <br /> -2 - <br />