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• ' City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: — (o 'p <br /> PO Box 66 Per2 mit umbar. 2c tD <br /> E <br /> 0NQ Crystal Bay,MN 55323-0066 �� D�tez r,, I q <br /> f` <br /> Street Address.' — Received by (��OK-ICI 1110 <br /> ~ �, 275Q iCae�ey Pa y P c 3113 z& o r i0- (r9 3 <br /> if: c? Orono.MN 55356 (9 q Z.°s • - 4,. ., .Plan . 't: 't i; <br /> sno4`` Main: 952-249-4600 Amt yy o Total Fee: -1—_ <br /> --- <br /> . <br /> Fax: 952-249-4616 www.ci.orono.mn.tis <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: ttsjo pt,p LR "ri-L tOriAV pcpti> - / cow M� S ri <br /> Will this be a Parade of Homes, Remodelers Showcase me or other Display Mt}rne? [ Yes OK No <br /> if yes,a special event permit is required with Police Department and City Council approval 80 days prior to the event. Shuttle bus service re be <br /> required unless applicant demonstrates sufficient on-site perking is available. Non permitted events will not be avowed. <br /> CONTRACTOR l APPLICANT INFORMATION: <br /> Name: -f irl E1,14/ Di Sh J :TIM f N61:ki <br /> State License# Expiration Date: <br /> Phone: (cell)(75i•1r-,5•-�i5i3 lofts) {, L2-oo. 3P 7-- ( K 'r1.) <br /> Mailing Address: 2 ,S5 PSS 0g -0A,j_j C t 2-0Contact Person: fl�. Mt C.*--t Applicant is: ra / Homeowner (circle One) <br /> Email and/or Fax: (Gini:I C,3C.t,.Qv► et_.) i ll t 1:-►+ij AE:6}, , Cly <br /> PROPERTY OWNER INFORMATION: <br /> Name: V-Deed�-T • fel=l 601-1104., <br /> Phone(day): {.e i7-•gdli*• 41. 5"-- <br /> Address: <br /> -Address: t t 30 Cat.-t) CV.tjf)- L, Wel tz-C S. City: V PV J b ZIP: 55- <br /> Email and/or Fax BEM- Sal KJE LL- Co EalvtAl p.• (at <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: 5C.5TT PePrP4OU CCI vit. A iblil.J PR-p*gSI C S) <br /> Phone(day): C152 . . "2— <br /> Address: <br /> Address: ¢Il0 ' LYN Oil-,tA S STE I4ZCO City: lamcw{f, ZIP: E--7--o <br /> Email and/or Fax: SCO'1"r P op clop- US . co <br /> PROJECT INFORMATION: Description ofproject: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> o New ConstructionWater Supply <br /> Jnr Single Family with 0 Accessory Bldg./Garage <br /> ❑Addition d d attached garage E Deck ❑Public Sewer <br /> ❑Accessory uildi i�ka,t�rr�i ❑ Single Family with Office/Commercial <br /> ❑ReIocation�(C m PrCi�tlOLA detached garage 0 Residence 0 Private Sewer <br /> g Other:(specify) ( RO01LQeT2 0 MultIple Family/Condo Retaining Wail(s) <br /> WA-(.4_, ❑Public ❑ 4 mor greater 0 Public Water <br /> ""Any earth movement may require 0 Commercial <br /> MCWD review&permits. ❑ Industrial 0 Warehouse <br /> Minneheha Creek Watershed District(MCWD) DI Other. (specify) ® rt O :.,„ ) ❑Private Well <br /> 15320 Minnetonka Blvd PER-0.0 . <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> wv,w,minne hehecreek.orq <br /> Estimated Construction Valuation(excluding land) $ 4 OM <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />