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�i, 3 �- , �5 <br /> � <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> : -- � Mailing Address: Permit number. —�(' � <br /> %'g,0,�:�� PO Box 66 <br /> � Crystal Bay,MN 55323-0066 Date received: - 7- oL. <br /> �%O� O �w� /^ <br /> �;�� ���'r'� ' �, � Street Address:' Received by: Yv�.-t— <br /> \����rv � /_ <br /> �� G�'� 2750 Keliey Parkway Plan review fee: 73• �fr� <br /> \�t�k�Ho¢w� Orono,MN 55356 ab l a—�0 g <br /> � —" Total Fee� <br /> Main: 952-249-4600 Fax: 952-249-4616 ;r;+;;,�.;_;i.�r.,:,�.;,�r,.u� <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: <br /> Will this be a Parade of Homes, emodelers SThowcase Home or other Display Home? ❑Yes ❑ t�le- <br /> If yes,a special event permif is required with Polrce Department and City Council approval 60 days prior to the event. ShutUe bus service wiI!be <br /> required un/ess applicant demonstrates suKcient on-site parking is available. Non-permitted evenis will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: C�ty; Z�p; <br /> Contact Person: Applicant is: Contractor / Homeowner �ci�one� <br /> Email and/or Fax: <br /> PROPERTY OWNER NF R.Mp� ION: �- � �.��— 1 <br /> Name: �V���w 1—! C �6�Z/ �6�'8��6 <br /> Phone(day): � <br /> Address: ��_� �v� City: ���Q ZIP: <br /> Email and/or Fax � � + - .., ., , <br /> ARCHITECT/ENGIN R NFORMA ON <br /> Name: <br /> Phone(day): . � � � � � <br /> Address: Ci . <br /> Emai�and/or Fax: <br /> PROJECT INFORMATION: • <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> �ew Construction �Single Family with ❑Residence <br /> Qg,Addition attached garage �arage/Accessory Bldg. ❑Public Sewer <br /> ❑Accessory Building ❑ Single Family with Deck <br /> ❑Relocation detached garage ❑Office/Commercial <br /> ❑Other:(specify) ❑Multi le Famil /Condo ❑Private Sewer <br /> p y ❑Warehouse <br /> ❑Public ❑Storage ❑Public Water <br /> "My earth movement may require ❑Commercial ❑Other(specify) <br /> MCWD review�permits. ❑IndusVial <br /> ❑Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Qther:(SpBcify� <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952�71-0590 <br /> Fax� 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) 5 �V��U <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />