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- .. . . � • ... . . . . . .. .' ,.. .. .. . ... _ . _ <br /> � � City of Orono <br /> Building Permit Application �►I��v <br /> for New Structures or Additions <br /> Mailing Address: Permit number. ��� a-—C�/O �I S <br /> �,��. PO Box 66 <br /> /�: � <br /> Crystal Bay, MN 55323-0066 Date received: CO � Z9 -! � <br /> + �"`'"`-° Received by: <br /> �Il a '"�� -^'` a, Street Address:' <br /> �� ,��,�j„ �ti�' 2750 Kelley Parkway Plan review fee: <br /> 't , `F'�r/ Orono, MN 55356 <br /> w <br /> \'�Es�o4 J�,/5 <br /> �:____-'' � <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <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: ��';5 y17,���,� ��v�_ D�`���7a /�� � -%5 5�4 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Disp ay 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: -, <br /> State License# Expiration Date: <br /> Phone: (office) (cell) :� <br /> Mailing Address: City: ZIP: <br /> � <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: /���a f�'�= �r��r1��.� <br /> Phone (day): ,;,�-2�0 -yo � � <br /> Address: l�Zs NL1.�r/d,'� o4ve- City: c�i�'�,��v ZIP: ��3G y <br /> Email and/or Fax �yju�Kd�c,� � Joo, coa� <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. [q Public Sewer <br /> ❑Accessory Building ❑ Single Family with ��'beck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> [� Other. (specify) �Cccf J�" �'��5F�v� ❑ Multiple Family/Condo ❑Warehouse <br /> OccK ❑ 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.min�ehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �G�, �' G + <br />