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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> , Mailing Address: a���_�/ �a <br /> ��T PO Box 66 Permit number: <br /> � `v0 Crystal Bay, MN 55323-0066 Date received: / z/ � -/� <br /> Street Address:' — �ved b : <br /> y � 2750 Kelley Parkwa � Plan review fee: /� �' `7S <br /> F c,` Orono, MN 55356 �����"7�'_ �� � ' d " �� <br /> ��kesF�o�� Main: 952-259-4600 Total Fee: � �C� 2 �) <br /> Fax: 952-249-4616 ww�v_ci orono_mn us J <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: ,N� E <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service ill e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ��u<-r�� 1 1o25C,MlED � SouTNv;��nl �s��t.� <br /> State License# N /� Expiration Date: <br /> Phone: (cell) �q�z q23- � iS"9 (office) (�si� Zo�- 30�� <br /> Mailing Address: �,- ` Cit : sT, l�nu� ZIP: S-i o <br /> Contact Person: `/„<,-�..� Do4.SGMi��7 Applicant is: ontractor / Homeowner (CircleOne) <br /> Email and/or Fax: ;�)o�<c4�;e d/J����-I�,✓�r�adpc�c,n .n orr+ <br /> PROPERTY OWNER INFORMATION: <br /> Name: o,,n <br /> Phone (day): 3 3 -- ¢So 0 <br /> Address: �,�02 O[.So�v �Ul�.noe-�.a�. I�-f��� City: �o���,�, U��,,Cy ZIP: ��'42Z <br /> Email and/or Fax ',�,�(�J G,,,, p�ep�TG,�,p S.�onn <br /> �--0=7- y- <br /> ARCHITECT / ENGINEER INFORMATION: <br /> Name: (',�U'�` b��c�r.l 4�eu��cC�ohJ�c�S <br /> Phone (day): �q�z� 3a 3 - S3�Z- <br /> Address: ���q �,yN�,4-r,�. /�s�, S . �-r� 70o C�tY� C,G6MiA1CTUn1 ZIP: 5'S'�4Zo <br /> Email and/or Fax: S�-e�e� (�c.d D -c-�5.C��►-� <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� <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 /> �Other: (specify) QF-� ,P ,�.nr�[�a�t,� ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "'Any earth movement may require ❑ Commercial �Other(specify) <br /> MCWD review 8�permits. ❑ Industrial e�-r,�i,.,i�l���r,�5 ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) Other: (Specify) <br /> 18202 Minnetonka Blvd �Ta�NI�/C� 1n�TS <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � (1 0�o <br /> r <br /> Packet Last Updated: April 2014. <br /> Page 17 of 19 <br />