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. � � l� � <br />' City of Orono 1��� <br /> �� �� <br /> Building Permit Application � <br /> for New Structures or Additions <br /> ,,e-.t:,s <br /> Mailing Address: a� <br /> ��� - � Permit number: ;�D� "DUG 1 p ��-,�,;i� <br /> � �,��\� PO Box 66 , <br /> ��� � Crystal Bay, MN 55323-0066 Date received: J Z ^'�����C� � �� � <br /> � :_ �� ,, , <br /> � a (�r� __ a;� Street Address:' Received by: �'��� �r:�>�� �� �G k (L j✓c'� <br /> `A � Z, 4' ` F, � �i 7/-'�S <br /> \\LF�u����2��Gti� 2750 Kelley Parkway ni C,�� ���a� Plan reviewfee: Z �y] � <br /> 9k E 9 H�� Orono, MN 55356 t� <br /> -- Total Fee: <br /> Main: 952-249-4600 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: ���� mc�c:-K � r��%4'� �e ° <br /> Job Site Address: � �- '�. $�pCk �..� 1�l Tv I`�, � C.a.'Q -3at��a3� bo� I� <br /> Will this be a Parade of Fiomes, emodelers howcas Home or other Display Home? ❑ Yes ❑ No (�-�^$� <br /> If yes, a special event permif is required with Police Department and City Council approva160 days prior to the event Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INF RMATI N: <br /> Name: u �' � � f`� ,(� <br /> State License# Expirat'yon Date: <br /> Phone: Q � - office V � 6 - yl�� cell <br /> Mailing Address: �' /�,t 0 Cit : t ��✓� ZIP: <br /> Contact Person: (p {,n/� qr ,�V� ,q/�, �pp icant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: (y �,/�I1. 1` ,� � yq Q/� il1(, �. <br /> PROPERTY OWNER INFORMATION: n M �Q I <br /> Name: 3� U�.�(. � �A1`1��� S 'iCO�� d" V�ti1 C�f�,Gl,(.` Y��'1 <br /> Phone(day): � . (p- / � <br /> Address: 30a.3. � 0 �„q�, Cit : ZIP:�'J~J'�3S�p <br /> Email and/or Fax (` <br /> ARCHITECT/ ENGINEER I FORM TIO ` r <br /> Name: ��U�, 171�0(j <br /> Phone(day): (� � - 5 ,y� <br /> Address: (���,,, { , � S� Cit :1'11 nM��0�1� ZI P:5'rJ 3�� <br /> Email and/or Fax: D� tJ` irl'l!. �,'�S4f C 4 GC . CD <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 f�„Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck C�� <br /> ❑ Relocation detached garage ❑ Office/Commercial � Private Sewer �`'r <br /> ❑ Other:(specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> *"'Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial �$,Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other:(speCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � — <br />