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� . . . � . . . _ . , . � ..�i � � . i � . �. ' ... � .. .. - . <br /> � � <br /> �. � � � � � .� � . . . ... .. � � . <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> �O Mailing Address: Permit number: �C�— U��� � <br /> PO Box 66 <br /> 0 � <br /> �� Crystal Bay, MN 55323-0066 Date received: %/ �J C <br /> � ��;� <br /> '?�����` s, Street Address:� Received by: r <br /> Y 4.-:::,� <br /> � ��4���'� 2750 Kelle Parkwa ._,_.- <br /> �' h�•�..�. o'`F� Y Y Plan review fee: <br /> LRkE5H�4� Orono, MN 55356 <br /> /�r �7� <br /> Total Fee: " ��� � �j!' �Gj <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us r1' <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: ,2G O s- 1 y��' G r� �,'rc�e <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a specral event permit is required with Police Department and City Council approval 60 days prior to the event. 5hutt/e bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP C T INFORMATION: ��/ <br /> Name: , Sc� / Z /7�So r. ��• <br /> State License# ) Expiration Date: <br /> Phone: 2 _ � j7i (office - Ge�S - ZG <br /> ,� cell <br /> Mailing Address: (,�J , a / �,e K Cit : S, ZIP: - � <br /> Contact Person: Z Appli nt is: Contract r / Homeowner (Circle One) <br /> Email and/or Fax: Z _ -��/ <br /> PROPERTY OWNER INFORMATI N: <br /> Name: �s. �,, n r t �eC�� k <br /> Phone (day): _ �- <br /> Address: ,�Ga r �� �Q� �1 ; rc�� City. [�io,,,Q ZIP� SS'3 3/ <br /> Email andlor Fax <br /> ARCHITECT/ ENGINEER INFOR ATION: <br /> Name: <br /> Phone (day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> ❑ New Construction �Sin le Famil with �Nater Supply <br /> g y �'Residence <br /> ❑ Addition attached garage ❑ Gara e/Accesso Bld <br /> ❑ Accesso Buildin 9 rY 9� ❑ Public Sewer <br /> rY 9 ❑ Single Family with ❑ Deck <br /> �Relocation detached garage ❑ Office/Commercial <br /> Other: (specify) �P✓►'�B�e I ❑ Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑ 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) $ � �. Q d <br /> Last Updated: 9/29/2009 <br /> - 17 - <br /> � �. , , , . .. <br /> � � . _ ,�, <br />