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� City of Orono S <br /> . � <br /> Buildin Permit A lication � �� <br /> J pp � <br /> for New Structures or Additions <br /> Mailing Address: Permit number: ��p ^ ��„5 <br /> Q PO Box 66 <br /> � �Q Crystal Bay, MN 55323-0066 , (� Date received: —��"/ (,o <br /> /��.. <br /> Street Address:' �• � Received by: y � <br /> � 2750 Kelle Parkwa •j� <br /> ti � y y /l Planreviewfee: � • <br /> �' c. Orono, MN 55356 <br /> ��kESH�4� Main: 952-249-4600 � Total Fee� �� ��O f�,j5 <br /> Fax: 952-249-4616 •�h�,�,�,n.ci.oronc.mn.us �SU'DW�' <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: �Lt[S�(��o 1� e.i r'G�t�_— L on� L.a..6C"�. � (/Yl ►rl .5.53.$"� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or oth r Display Home? ❑ Yes No <br /> If yes, a special 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/APP ICANT INFORMATION: <br /> Name: � ' LL�. <br /> State License# Expiration Date: 3- 3/— / <br /> Phone: cell office - - p <br /> Mailing Address: Cit : • P: c <br /> Contact Person: Applicant is: on ractor / omeowner (Circle One) <br /> Email and/or Fax: • ` . � � <br /> PROPERTY OWNER INFORMATI N: I <br /> Name: r,�,yy1 oC,`�g"f'q.,C� <br /> , <br /> Phone (day): G��_` �� _��'�� <br /> Address: /s1rg- yy�c�vl.e�,• i r�-(�- City: �y� , n J�Q ZIP: �'-�'�.�� <br /> Email and/or Fax q,n,�,-�s}��j �� �b�r�l-r;�Ie,�n.�s <br /> ARCHITECT ENGINEE NFORMATION: <br /> Name: � • ' ,L(.,,� <br /> Phone (day): _ _ <br /> Address: �o �.,�y� �(o City: � vi r� ZIP: J�'- ' -r, ��t� <br /> Email and/or Fax: � <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction �Single Family with ❑Accessory Bldg./Garage <br /> �Addition attached garage ❑ Deck ❑ Public Sewer <br /> Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage �ftesidence �`Private Sewer <br /> ❑ Other: (specify) ❑ Muttiple Family/Condo 'f� Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑ Other(speCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding'IaEnc7f����� $ �(, R� � �' <br /> � . % 0 2016 <br /> Packet Last Updated: August 2015 CITY OF ORONO <br /> Page 21 <br />