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� � �S�G� ��� �/0 -dC�7o� <br /> f� 1� <br /> City of Orono <br /> Building Permit Application ,�� �,� �� <br /> for New Structures or Additions � � �� �oy � <br /> �-=�� Mailing Address: Permit number: D�O-DO <br /> �, \\ PO Box 66 <br /> Q Q; Crystal Bay, MN 55323-0066 Date received: � /O <br /> �'c. <br /> 5�+�m Received b <br /> �a � �;�:�,:�� s,j Street Address:� y� <br /> �� � �� `� 2750 Kelle Parkwa <br /> 'F'��, �' �•�, ��� Y Y Plan review fee: <br /> �'kE3H04� Orono, MN 55356 � <br /> Total Fee: � <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � O U � <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: � � � � ����? 'j/1 ,.T' � �/�� �-� �' <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. Shuttle bus service ll 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: -�S /7? !f�/L �fy ' Ct�S �l1 �c� t l.��c'�< > <br /> State License# Z-.o � � LJ 'Z, S y Expiration Date: 3 � /r <br /> Phone: ••''L 2 �3 office G�i Z � �1 �1'G' cell) <br /> Mailing Address: � � � G- U�/ - �j-- Cit : � N� �Z��ZIP: 3 � <br /> Contact Person: ��C Applicant is: Contractor / Homeowner �c���ie o e� <br /> Email and/or Fax: ����-� ���UC��� �y�ti <br /> PROPERTY OWNER INFORMATION: <br /> Name: �Cc,iLc;�t � G�'l�-t�1 '7`Z(.' O✓�t ���/ <br /> Phone (day): / - Z! � - ��3 p c�o '7 �` <br /> Address: jS �� l�uf--i�ti'� U:Z� !� q !� Cit : �/G�-� ZIP���3��/ �j <br /> Email and/or Fax <br /> ARCH(TECT/ ENC�INEE ,INFORMATION: <br /> Name: �i�7 G�G�e'_ �-�i-t �vCGG��FC'c;f��/a'� j c�/c,� <br /> Phone (day): �'�' L �'� � y `S� <br /> Address: " `S'E�� W �s ;,l irG�z,�v � Sy Cit : ��iN4 ZIP:� S��� <br /> Email and/or Fax: �5���, � ,�"'r��c��.r-:- . C.�� <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> ❑ New Construction Water Supply <br /> ❑ Single Family with ❑ Residence <br /> ❑ Addition attached garage ❑ Gara e/Accesso Bld <br /> ❑ Accesso Buildin g rY 9• ❑ Public Sewer <br /> ry q ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> �Other: (specify)�'�✓l�-0 R��`Gf ❑ Multi le Famil /Condo ❑ Private Sewer <br /> �° p y ❑Warehouse <br /> ❑ Public ,❑ Storage ❑ Public Water <br /> '"`Any earth movement may require ❑ Commercial '[] Other(specify) <br /> MCWD review 8�permits. ❑ Industrial f�c�jPg7 !leGi.�' ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) '�Other. (specify) <br /> 18202 Minnetonka Blvd ���� �-(dL� <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ��p � ,.�-J .-. �U ��, <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />