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`� �l <br /> City of Urono -� � � � ` <br /> � <br /> Building Permit Application � y� <br /> for �lew Structures or Additions �:��`� <br /> Mailing Address: � <br /> ����`, PQ Box 66 Permit number: '- � <br /> �. <br /> (� `�, Crystal Bay, MN 55323-�J�J56 Date re�eived: � —2 � — <br /> ��t� Streef Address:' — R��e ived by: - <br /> `,, �\! � ,1 2754 Keiley Parkway � t�� �� <br /> � , �(�E Pfan review fee: � � ����� <br /> `� ' c�`;' Orono, �AN 55356 � �'�. <br /> �'��"�Es Ho��;,� Main: 952-249-46�0 �-�'"�I �5J� __/ <br /> � -" Fax: 952-249-4�16 �4var�wf;.�ron .mn.u� —��____.__ _ <br /> 7hi5 cippflGat10n forlTl rT'1USt b2 GotTtpleted in f�tll atld a(I reqUir�d Irt�Orrr►atlply rrtUSt b�5Ubrt'1ltted. <br /> incompEete applica#ions wilf be returned. (Please prinfl <br /> GENERAL INFQRAtIAT10N: <br /> Job Site Address: (� � - , <br /> Will this be a Parade of Homes, Remadelers Showcase Home ar at r Display Home? [] Yes No <br /> If yes,a special e.venf permit is requ�red with Palice Department an�City Cvuncif approval 6�days prio�tc�the event. ShutUe bus servrce will be <br /> �equirad untess appli�ant demonsirates suflir,renf on-sife parkir�g is�valfabte. lUon-,��rmr#ed Pvents�v�ll nc�f t�ailowed. <br /> CONTRACTOR t APPLICANT WFORMATION: <br /> Name: - <br /> State�icense# �����;y�1 Expiration Date: <br /> Phflne: � (cell) (office} <br /> Mailing Address: — - Ci : ZlP: <br /> Contact Person: ;� Appiicant is: ontrac or J Homeowner (Circte One) <br /> Email and�or Fax: � .� � .. ✓ � <br /> PROF'ERTY OWNE IIVFORMATION: <br /> Name: ���a,��S /"r�•�t �E d��L��� <br /> Phone{day): <br /> Address: i°�p0 �.t��c� f�.il C�h`:�Y-e�c�l'r"� ZIP: ���'7 <br /> �mail and/or Fax <br /> ARCHITECT!ENGINEER INFt3RMATION: <br /> Name: 1�±����. 1.�:N�C�:.� <br /> Phone(day): <br /> Addr2SS: a.• .� Ciiy: ���i�GkL ZIP: .�_C'��.'7 <br /> Email andlor Fax: — � � �. �, � <br /> PROJECT INFORMATION: Descriptic�n o#pro�ect:__ <br /> 1.Type of Pro}ect 2.Proposed Use 3.5tructure Type 4.Sewage Dlsposal& <br /> Water Supply <br /> New Consiruction [�Single Famify wiFh ❑Accessory Bldg.%Garage <br /> ❑Addition � attached garage ❑ Deck Public Sewer <br /> ❑Accessory Building ❑ Single Fam€iy with ❑Office�Commercial <br /> ❑Relocation detached garage ❑ Residence ❑ Private Sewer <br /> ❑Other. (speci#y} ❑ Muftiple Family 1 Condo ❑ Retaining Wall(s) <br /> ❑ Pub(ic A-feet or greater ❑ Public Water <br /> **Any earth movement may require ❑Comn�ercial ❑Starage <br /> MCWD review 8 permits. ❑ Irdustrial ❑Warehause �Private Well <br /> Minnehaha CreAk VYatershed District(MCWD) [�Qther: {sper.ify) ❑C7ther(specify? <br /> 15320 Minnetanka Blvd <br /> Minnetonka,MN 55345 _______ ___.__._____. <br /> Phone_ 952-471-05�D <br /> �ax: 952-4%1-OB82 <br /> www.minnehah7acregk.or <br /> Estimated Construction Valuation (excluding lar�d) � 7�� �� � <br /> Packet Lasi U,�dated: Augus!2D15 <br /> P�age 21 <br />