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, ' �+ � <br /> � <br /> . ;1 City of Orono � � <br /> !li� Buildin Permit A lication � � � <br /> (� J pp �a ��3 <br /> for New Structures or Additions <br /> Mailing Address: permit number: (a' �� <br /> ���►�,j�.\ PO Box 66 <br /> � � Crystal Bay,MN 55323-0066 Date received: �`" Z'` <br /> �I �''��i,.�"�_ �� Received by: <br /> 1, Street Address:' <br /> \\�'�,c,r ,�� ���'�/ 2750 Kelley Parkway Plan review fee: 3l� ,�J <br /> ���g,�/ Orono, MN 55356 <br /> :_���� �o�a-ooyov <br /> _- Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us f L.pqp <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: / ��� La. Ke�� ��� 1� v � ��a�z�-�-� /'�'� I� 553 `� I <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Displa Home? Yes �'No <br /> If yes,a special event permit is required with Police Department and City Council approva/60 days prior to the event. Shutt/e bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/ PLICANT INFORMATION: <br /> Name: � c�-t-N��rr.G- Sr�r�O�r' <br /> State License# Expiration Date: <br /> Phone: _�� -�{7,3- (�S/5 (office) (cell) <br /> Mailing Address: L.� � w � Cit : ZIP: <br /> Contact Person: N o r mcx. ��L�rw o r Applicant is: Contracto / Homeowne �c�r�ie o�e� <br /> Email and/or Fax: n� r n.a. S c 1.r�n r � n r��-�.Co r-� <br /> PROPERTY OWNE INFORMATION: <br /> Name: �o �Q � /�)n r r�c� SGh►�c,o r <br /> Phone(day): g�a, S/a. -�IoS3S �No r�a.- wOr k, <br /> Address: J ��p L� �e_� ;e�.; rR- �e City: W 0..�u,`�c,.. Z�P: �i 553�1 I <br /> Email and/or Fax n n r r��. S� h noo r (� S ea r� �r�. nn r-4�s. c 6 w. <br /> - .., <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <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 �a'Garage/Accessory Bldg. .c[�'Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑Office/Commercial ❑ Private Sewer <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.minnehahacreek.or <br /> Estimated Construction Valuation(excluding land) $ �O��(�('� <br />