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. � <br /> . �.� <br /> ��� City of Orono g� 5� .�S' <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: ��3—6Z��7� <br /> Q�r PO Box 66 <br /> � `V� ��� Crystal Bay,MN 55323-0066 Date received: � �Q '�3 <br /> �� StreetAddress:' Received by: <br /> y� � 2750 Kelley Parkway Plan review fee: ����. � <br /> c,� Oro�o,MN 55356 <br /> `qkfSHO�� � Main: 952-259-4600 Total Fee: av� ��`�7� <br /> Fax: 952-249-4616 �, � ���� ���( -uQ- <br /> This application form must be completed in full an�d all required information must be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 4 3 i o 5 , <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display 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. Shutt/e bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is evailab/e. Non pemritted events wil/not be allowed. <br /> CONTRACTOR!APPLICANT INFORMATION: <br /> Name: -.I Gu sT" o r��S L c, <br /> State License# 8�- �3 9'1 z'1 Expiration Date: a 3 31 i <br /> Phone: (cell) G it - ��7 _�9 5,�'j (office) �`3-�4(-� ��9 <br /> MailingAddress: � Sro,�� P��v TR U+c Cit : w ��'G� N ZIP: 5 ?q <br /> Contact Person: �.s MvL.R.$�{NJ�ry Applicant is: Contractor / Homeowner (Clrcle One) <br /> Email and/or Fax: w,d(re,�,.a►. �...,r�c.Mtte�.hewcs .c.nti <br /> I�1 U i r�e.r�����y'1 <br /> PROPERTY OWNER INFORMATION: <br /> Name: �R•t9 �' P�T G�-�c�si..�-r►o <br /> Phone(day): 1�?-5�'I -�5�1 <br /> � Address: �'j v.o J v N E�t v �� �tv_ City: (�-Y+�ou t}l ZI P: �5 �l, <br /> Email and/o az ���- ��q - 2b*�9 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: SK9 AP��u+r�cTS <br /> Phone(daY)� '7�3 - �41 -G 1�5 <br /> Address: t�1�o N�`f 55� S?"�. ,� City: p�.�,,.o��,+*a ZIP: ��5 d.�.� <br /> Email and/or Fax: ?c 3 - 5y� - 6��q <br /> PROJECT INFORMATION: Description of ro'ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Dlsposal& <br /> Water Supply <br /> � New Construction ❑Single Family with �Residence <br /> ❑Addition attached garage �Garage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Building � Single Family with ❑Deck <br /> ❑ Relocation detached garage ❑Office/Commercial ❑Private Sewer <br /> ❑Other: (specify) ❑Multiple Family/Condo ❑Warehouse <br /> ❑Public ❑Storage ❑Public Water <br /> "*Any earth movement may require ❑Commercial ❑Other(specify) <br /> MCWD review 8�perrnits. ❑ Industrial <br /> �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.minnehahacreek.or <br /> Estimated Construction Valuation(excluding land) $ �,,�ao aoo or <br /> 7-+ <br /> Packet Last Updated: 04J19/2013 <br /> Page 22 of 23 <br />