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�ity of Orar�o � <br /> � ` ����c���� Permit Applicatfor� <br /> f�r �er� �tructures or �4ddit���s <br /> Mailing Address: Permit number: / ' /� <br /> Q�T PO Box 66 a� 7��L)�7^�� <br /> � j VQ Crystal Bay, MN 55323-0066 Date received: c,2-� !o-/7 <br /> Street Address:' Received by: �j� `Y C <br /> ---- — <br /> y ,� 2750 Kelley Parkway = ,-�'1 <br /> �' L� Orono, MN 55356 Plan review fee: �, 7 �S, o�� <br /> t'kESH��� Main: 952-249-4600 � I TotaiFee: �! ?��� �S <br /> Fax: 952-249-4616 www.ci.orono.mn.u� !- � � • � - : ( `t <br /> This appiication form must be completed in fuil and afl required information must be submitted. <br /> Incomplete applications will be returned. (P/ease print) �l,�,f� ��Jf�:� <br /> GENERAL INFORIVIATION: <br /> i <br /> Job Site Address: U Y� rc � �; '� I�r ;.�� <br /> Will this be a Parade of Homes, Remodelers Sh wcase Home or other Display Home? Yes ❑ No <br /> If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service will be <br /> required unless applicant demonstrates sufficienf on-site parking is availab/e. Non-permitted events wil/not be allowed. <br /> CONTRACTOR/APPLICANT INFORIVIATION: <br /> Name: _ �'3 e��y�q � wt� S <br /> State License # ��S� Expiration Date: <br /> Phone: _(cell) (o j� -� y j_ ����j (office) <br /> Mailing Address: Cit : Z�p. <br /> Contact Person: � Applicant is: o�it�actor / Homeowner (Circle One) <br /> Email and/or Fax: .� ' -, � � o • o � � . o �-.-- --- <br /> PROPERTY OWNER INFORMATION: <br /> Name: �_c�v�c., 1��r�� c <br /> Phone(day): <br /> Address: City. Z�P. <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP• <br /> Email and/or Fax: <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: Z�p• <br /> Email and/or Fax: <br /> PROJECT INFORI1AATiON: Description of pro'ect: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal S <br /> Water Supply <br /> �w Construction � ingle Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck <br /> ❑Accessory Building ❑ Sin le Famil with ublic Sewer <br /> ❑ Relocation 9 Y ❑ Offce/Commercial <br /> detached garage ❑ Residence ❑ Septic <br /> ❑ Other:(specify) ❑ Multiple Family/Condo ❑ Retainin Wall s <br /> 9 � ) (Compliance certificate <br /> ❑ Public 4-feet or greater may be required) <br /> **Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review 8�permits. ❑ Industrial ❑Warehouse ' ublic Water <br /> Minnehaha Creek Watershed District(MCWD) � Other: (specify) ❑ Other(Specify) <br /> 15320 Minnetonka Blvd;Minnetonka,MN 55345 ❑ Private Well <br /> Phone: 952-471-0590 / Fax: 952-471-0682 <br /> wv✓w.m innehahacreek.ora <br /> Estimated Construction Valuation (excluding land) $ � §�) �,�� <br /> Packet Last Updated: January 2016 ' <br /> Page 21 <br />