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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions (111` -q-)g' <br /> Mailing Address: Permit number: 02[x!F-moi D <br /> QA? PO Box 66 <br /> l�'o Crystal Bay, MN 55323-0066 Date received: / - 1./-/S' <br /> Street Address:' h '1 Received by: �- <br /> 2750 Kelley Parkway �✓ Q <br /> � � � Plan review fee: 3i S,5 <br /> 6� 0 Orono, MN 55356 <br /> `-lktsHo4- Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.rrin.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: CoJob Site Address: 2l0 95 CLAn-rilz-y‹ti E D-. t -' <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ YesNo <br /> If yes, a special 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: L i TE Cot.,s-crt-ocn o rte-' l 1v C • <br /> State License # l y So Expiration Date: 3 71 9 <br /> Phone: (cell) (o 12 - (a g 5 - 56 Z--7 (office) <br /> Mailing Address: too Bolt 38 City: i-/Aaoi€Ye ZIP: SS 3Y/ <br /> Contact Person: E 2t c. Applicant is: ntractor / Homeowner <br /> pp o (Circle One) <br /> Email and/or Fax: <br /> ER(c., Li TE C'o ria 5- -Gt C--rro,..L IVC . <br /> PROPERTY OWNER INFORMATION: <br /> Name: Sc 0 " T 4- 4-toL(..21 ' .(C.KrE-r-T <br /> Phone (day): 6012 -- 8108 -- 3c4 (q <br /> Address: .. 9 5 Cow�.r4 s,pE pr ltf City: Lo ZIP: 5- <br /> Email <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: (.. i TE CmfuS T �. <br /> Pc Cin 0 NJ /41-`7/A1 Al it1Et.(.02 'ate d— ASST <br /> Phone (day): Li S Z -- q p 41-. -7 ZZ 3 <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: r2--tot..0 oc t_ gAS0Mi,JY <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> ❑ New Construction Sin le Familywith Water Supply <br /> 9 ❑ Accessory Bldg./Garage <br /> ❑Addition ttached garage El Deck <br /> ❑ Public Sewer Accessory Building 0 Single Familywith 0 Office/Commercial <br /> 0 Relocation detached garage 0 Residence <br /> ❑ Septic❑ Other: (specify) nENID-DE _ 0 Multiple Family/Condo0Retaining Wall(s) <br /> (Compliance certificate <br /> ❑ Public 4-feet or greater may be required) <br /> **Any earth movement may require 0 Commercial 0 Storage <br /> MCWD review& permits. 0 Industrial ❑ Warehouse 0 Public Water <br /> Minnehaha Creek Watershed District(MCWD) 0 Other: (specify) 'Other(specify) <br /> 15320 Minnetonka Blvd; Minnetonka,MN 55345 <br /> 0 Private Well <br /> Phone: 952-471-0590 / Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ '-- r o00 <br /> Packet Last Updated: January 2016 <br /> Page 21 <br />