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, , City of Orono <br /> . � o. i� <br /> , Building Perm�t Application �9 <br /> � for New Structures or Additions <br /> � Mailing Address: (.r •�.- ` � <br /> Q�T PO Box 66 ��� Permit number: ; / C' <br /> � `VQ Crystal Bay, MN 55323-00 �� Date received: � '-1C� ` �� <br /> Street Address:' � _..,.. 1��ceivedbX:__....._ _ ��t`_�' "E'�YZ <br /> � ,� 2750 Kelley Parkway ..- � <br /> y� � ��� ��t�� PI�{review�: � <br /> � � Orono, MN 55356 , �; , _ <br /> qkESHO�� Main: 952-249-4600 ''"-``'" otal Fee: Tu <br /> 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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � �,� � ����,,,� ��, � <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 required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service wil!be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events wil!not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: '��.�iA-P� � I�l�T2'i� <br /> State License# � Expiration Date: <br /> Phone: (cell) l2 7s0� ��I _ (office) <br /> MailingAddress: _��j r �}�y� ��. , City: ���,�D�c'���+R� S5� <br /> Contact Person: ��- Applicant is: Contra r / Ho. eowner\ (Circle One) <br /> Email and/or Fax: �, r, ��, ,�-a-r�'c�t���.� , �'� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �Ez«`1-►i% � tr�•z4�� <br /> Phone(day): ��-- ' '/.�— � ✓ -� �° <br /> Address: ���7 , �j�sz� �, City: ���/lf� ZIP: j���� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> ARCHITECT I ENGINEER INFORMATION: • <br /> Name: 7��C��'" '/7v.�'iC'� �7/"�s'L�-!� <br /> Phone(day): "L-� � ?.�� <br /> Address: t��7/ �'� T /� p �- City: ���y��� ZIP: .`�,,3�` � <br /> Email and/or Fax: <br /> f �f ���«� <br /> PROJECT INFORMATION: Description of project: t�t'� � , -'7�'� /�Z 7�'/' et,�t 1 � ' ,�� - <br /> 1. Type of Project 2. Proposed Use � 3. Struct re Type 4. Sewage isposal 8� <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 1 � ` detached garage � Residence ❑ Septic <br /> [�Other: (specify) 4+u��d� � ��� ❑ Multiple Family/Condo ❑ Retaining Wall(s) (Compliance certificate <br /> ❑ Public 4-feet or greater may be required) <br /> **Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑ Warehouse ❑ Public Water <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (speClfy) ❑ Other(speCify) <br /> 15320 Minnetonka Blvd;Minnetonka,MN 55345 ❑ Private Well <br /> Phone: 952-471-0590 I Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ � • qDfl <br /> � � <br /> Packet Last Updated: January 2016 <br /> Page 21 <br />