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� <br /> ( ► � �,� � : - <br /> � <br /> , � � `�'�� !n, ,�- <br /> . � 1 <br /> City of Orono � � <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: �I QOr <br /> Permit number: - G�(� �' <br /> �g,�,�.� PO Box 66 � C.,��, v � <br /> �Q �, � , Crystal Bay, MN 55323-0066 ' Date received: d� � _� <br /> � �°� 1 � Received by: <br /> i,� �'. �:� �, Street Address:� <br /> �:,,.,,> <br /> �'.�n '�%� �ti 2750 Kelley Parkway ; Plan review fee: <br /> t`�kEsxo4'� Orono, MN 55356 � <br /> Total Fee: ��a`7� � <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: / � �� ���� <br /> Job Site Address: / � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes, a specral event permit rs required with Police Department and City Counci/approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking rs available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATIO : <br /> Name: ,j�a�, �-J�/ie �u�iC,�'�'l e.i^ <br /> State License # Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER NFORMATION: <br /> Name: f'� �YJu�i�.e 1PG��/�I er' <br /> Phone (day): 5 D <br /> Address: Cit : C� ZIP: ��' <br /> Email and/or Fax '�,�. � o <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 I, 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 Bfdg. �Public Sewer <br /> � ❑ Accessory Building ❑ Single Family with Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial I� ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse ! <br /> I ❑ Public ; ❑ Storage I ❑ Public Water � <br /> I "`Any earth movement may require ❑ Commercial ❑ Other(specify) ' <br /> MCWD review 8� permits. ❑ Industrial �Private Well I <br /> Minnehaha Creek Watershed District(MCWD) , ❑ Other. (speCify) � <br /> 18202 Minnetonka Blvd ' � <br /> Deephaven, MN 55391 I� i <br /> Phone: 952-471-0590 i <br /> Fax: 952-471-0682 i <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � � ,f�� <br /> Last Updated: 6/22/2009 <br /> AAo�vO�„� �o �,w�T Zooq- c�nz.c�t� <br /> - 19 - <br /> 3 0�? 6�9 M yR l�.1� 'b r s s� r/�'�''''"� "'" f�ni�-�- ��j e_ <br /> �q �� � no.J �F /'�t�w- P+ l <br />