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City of Orono �r,,,� i:��,� , �5 .�� <br /> Building Permit Application � �. ���,-�� JI �� T <br /> for New Structures or Addit' s r�� �i1�� � <br /> MailingAddress: Permitnumber: p —Dd3�0 <br /> �0/���,�.� PO Box 66 <br /> Q Crystal Bay, MN 55323-0066 Date received: �z ���� <br /> � <br /> �I �#,�=� � � Received by: �`�-� <br /> II,a r�� .:. a., Street Address' <br /> � ����y �w/ 2750 Kelley ParkwaY � Plan review fee: o2Q/a—D d 3e� <br /> �.AESH�g� Orono, MN 55356 � � Ly <br /> \�'�=_=/ Total Fee: � <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us (��(;,rjJ�/� ���(�i <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete apptications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � (,> r K �-t- ' ; t� ;, , � L�t, L'��� � p I�9/� S�3-S� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes,a special event permit is requi�ed with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed. <br /> CONTRACTOR/APPLI�NT INFORMATION: <br /> Name: � CAt,�� �r��e,rw <br /> State License# Expiration Date: <br /> Phone: G1.�- ��/U�- �675 (office) (cell) <br /> Mailing Address: gp µ,' k - 4 Cit : �;��;2 , ZIP: .3.5� <br /> Contact Person: u - r Applicant is: Contractor / �omeown �c�r�ie ooe� <br /> Email andJor Fax: pSo� era�D �r�. C.�:�+-t <br /> PROPERTY OWNER IN,�ORMATION: <br /> Name: _ t �!,( � S�bP.ru- <br /> Phone(day): G la - 8 yU -36 '7� <br /> Address: � (� yi�) �' iQ- - �,�Q � Cit : � �✓t D ZIP: �S 3S� <br /> Email and/or Fax �,�p �,-a � nf'sD�'U -- r pv� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: C��c�v �n�,n t e�r`nu . L L G <br /> Phone(daY): � �� - i a 3v o � <br /> Address: �� •�a j i he St-rakd City: /?i���,�P�o✓IKu ZIP: SS 3 5'�S <br /> Email and/or Fax: c����.r N��,`,, ,�r:';�� (� �S f�r�; Iv . �Jt f- <br /> , <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction �Single Family with Residence <br /> ddition 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) ❑Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage ❑ Public Water <br /> *"Any earth movement may require ❑Commercial ❑Other(specify) <br /> MCWD review 8�permits. ❑ Industrial -f Gt.�.0( �Private Well <br /> Minnehaha Creek Watershed District(MCWD) �Other:(speCify) � <br /> 18202 Minnetonka Blvd � �''� � <br /> Deephaven,MN 55391 <br /> Phone: 952�71-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> FctimatPrl Cnnctn ir.ti�n Valuati�n (Pxr.lu�linn lanril � <br /> S�OCi c.vu�l <br />