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,� <br /> . CITY OF OROIVO <br /> • a � �\� BUILDING PERMIT APP <br /> �C �,� LICATION <br /> FOR NEW STRUCTURES OR /4DDITIONS <br /> Mai/ing Address: � �l�P- � <br /> � njO Permit number: — , c <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � ?� - <br /> y � Streef Address:' 2�� <br /> Received b � <br /> � G. 2750 Kelley Parkw Z�;t(�'�� � Plan review fee: �crv��%1�-�� w <br /> t�kESHOR� Orono, MN 55356 � � Z� ��.�; —��,� j-�� -�� - <br /> Main: 952-249-4600 Total Fee: <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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � � �c ` � � �,�,� ,r ,� _ � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other isplay Home? ❑ Yes o <br /> If yes,a special event permit is required with Police Departmenf and City Council approval 60 days prior to the event. Shuttle bus service w�I be <br /> required unless applicant demonstrates sufficienf on-site parking is availab/e. Non-permitted events wil!not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATtQN•� � � <br /> Name: • r�p�, v <br /> State License# p Expiration Date: ' � d <br /> Phone: cell � -� �i` office -- <br /> Mailing Address: [ ( �!� � , <br /> Contact Person: � � Cit . ;�� �� a IP: <br /> � Applicant is: ontrac / Homeowner �c���ie o�e> <br /> Email and/or Fax: �r�a�,��,� ,�,-��,�� �� y�'�;��� � ",� <br /> PROPERTY OWNER INFORMATIO ` <br /> Name: ' � � `,� � y��,� <br /> Phone (day): � --�- <br /> Address: . 2 Cit : <br /> Email and/or Fax �. �„e. ��,v�� � � •� �.. �� Z�P' �� <br /> ARCHITECT/ ENGINEER INFOR TION1:_ , (� <br /> Name: J�,u i SP � t�'Tc�;{� �e`c �� � �1T c.c��' <br /> Phone (day): �. � <br /> Address: '7 h � Cit : ZIP: '"�'��� <br /> Email and/or Fax: ; ,n �; � <br /> PROJECT INFORMATION: Description of pro'ect: � � �9 vt B..�G�e G�'� e. `; �c�i�(� <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� <br /> ❑ New Construction Water Supply <br /> ❑ Single Family with Accessory Bldg./Garage <br /> ❑Addition attached garage Deck ❑ Public Sewer <br /> �ccessory Building l�cz/qG�Q, ❑ Single Family with ❑ Office/Commercial <br /> LJ Relocation detached garage ❑ Residence <br /> ❑ Private Sewer <br /> ❑ O t h e r:(specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> �*Any earth movement may also require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) �Other: (speCify) ❑ Othef(speCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 a� <br /> Phone: 952-471-0590 �� � q � <br /> Fax: 952-471-0682 ���� n ��,�� <br /> www.minnehahacreek.or rC, <br /> Estimated Construction Valuation (excluding land) $ �(� �'� <br /> . <br /> Last Updated: January 2015 <br />