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. - � �-��,-- l3 <br /> � , <br /> . � f��},��i, <br /> . C i ty of O ro n o (���.� '�-` �� �.5 <br /> 1 <br /> � Building Permit Application - <br /> for New Structures or Additions <br /> Mailing Address: Permit number: O�O/a-D��� <br /> O.¢,D,�.O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: (O-�-/Z <br /> � � �, StreetAddress:' Received by: l�-1��5 <br /> E, �ti�' 2750 Kelley Parkway Plan review fee: �O 7� � � <br /> �9.kE$H�g'�' Orono, MN 55356 �D<o2 - <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us ���-� �,(,`C� C� u/ (L�(p0 <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: �_3C� C7 �-c:}c��-.c L.i r1c�c ✓� a�t"e7 v�o � s'�� �S��� � <br /> Will this be a Parade of Homes, Remodelers Showcase 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. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �0.SOti ���S �a.L►�'1 <br /> State License# Expiration Date: <br /> Phone: j L� Z� — � office cell <br /> Mailing Address: ' p �r.� � v� Cit : C�dc�c ! ZIP: S 5 3b� <br /> Contact Person: �cks o•�. {-�, �.. +� Applicant is: Contractor / Homeowner'� (Circle One) <br /> Email and/or Fax: �1ti��s c.�c�,,.r„� W v�+ 1�j� t � �,� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ,Jcu..So,,� �JeSw.a K "1 <br /> Phone (daY)� ��( Z-- Z�`� - �'`f S 7 <br /> Address: '3d0 L�� L „c Cit : GVp /1/�,/UZIP: S � (� <br /> Email and/or Fax ; l� ��S���.� �J U,h,o o s[o+� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <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 ❑ Garage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Building ❑ Single Family with �Deck <br /> ❑ Relocation detached garage Office/Commercial ❑ Private Sewer <br /> '� Other. (specify) f�- ���t ���S}I<� ❑ Multiple Family/Condo ❑Warehouse <br /> C{c � A.�c1 �'�` ❑ 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 Minneto�ka Blvd T��L L <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � �d������ � <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />