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. , �-o� <br /> �' � � 5 <br /> - �111ED <br /> City of Orono APR z � ?.� <br /> Building Permit Application cmr oF c���� 5ss�.�s <br /> for New Structures or Additions 3�05�.75 Tz,��� <br /> Mailing Addiess: Permit number: - �/ 7� <br /> Og,�,�.0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> �, StieetAddress:' Received by: � '� � <br /> �. Gtiti 2750 Kelley Parkway Plan neview fee: �5 • Q � <br /> '���o�.� Orono,MN 55356 � �� ,1 �y��� <br /> Totai�'ee: do 09-vo/7� �` <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This applicatian form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be retumed. (Please print) <br /> GENERAL tNFORMATION: <br /> Job Site Address: 3 g(c PIpR}N HOQ <br /> Will this be a Parade of Hornes, Remodelers Showcase Home or other Display Home? Yes o <br /> If ye�s,a specia/e�nent permit is required with Polioe Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstiates suflscient on-site pa�ldng is available. Non-permitted events will not be albwed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: G�E�1 �E.'D'DE�1nnF�1 E2 <br /> State License# Expiration Date: <br /> Phone: (office) Ce I a-9 l�n-'I S O O (ce��) <br /> MailingAddress: O M� 't�N �.N ,.► l C� � o�v�, L�K ZIP: S S<o <br /> Contact Person: Applicant is: Contractor / omeown �ci�o�� <br /> Email and/or Fax: GIE r� eJ KM HEREC�ORS .CoM <br /> PROPERTY OWNER INFORMATION: <br /> Name: C�\E►.1 Net»F2n�EVEi2 <br /> Phone(day): Ce I� —`1!� - "1 S O� <br /> Address: "Toq M ��iNE?pNKq Ntc�t+lA�vc� L,v City: �oNy, �AkE Z�P: SS3S�o <br /> Email and/or Fax C,��,��kMHER Ec.�oR S.COrn <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 Disp�al 8 <br /> Water Supply <br /> �New Construction �ingle Fami�y with esidence <br /> ❑Addition attaChed garage �Garage/Acvessory Bldg. �ublic Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Dedc <br /> ❑Relocation detached garage ❑Offioe/Commercial ❑Private Sewer <br /> ❑Other.(speafy) ❑Mu�iple Family/Condo ❑War+ehouse <br /> ❑Public ❑Storage ❑Public Water <br /> "My earth movement may require ❑Commeraal ❑Other(specify) <br /> MCWD review S permi�s. ❑Industrial '�'�rivate Well <br /> Minr�haha Creek Wetershed DishiCt(MCWD) ❑p�tgr.(spepfy) <br /> 18202 MinnetoN�a Blvd <br /> Deephaven,MN 55391 <br /> Phaie: 952�71-0590 <br /> Fax: 952-471-0682 <br /> www.minne ha <br /> Estimated Construction Valuation(exduding land) ; l.�mp o ma ,d-�p <br /> f <br /> -18- <br />