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01/4.k.---, <br /> �5 � � City of Orono <br /> - ► -f-*ltwCV' Building Permit Application <br /> for New Structures or Additions <br /> ,„,---6,-,., <br /> Mailing <br /> Box 66 Permit number: c: C (c)--WLI y,7)� Crystal Bay, MN 55323-0066 Date received: 5�`I 11 / 0 <br /> / — exp, 0 <br /> a *.f '.` Si/ Street a Received by: ,,1 <br /> p�f a ParkwaCps.LLI <br /> is 15 <br /> c'� r <br /> *.j.kirttiyY� ;� Y q t3,oil Plan review fee: � � �'�� C,jc y a� <br /> ,c ono, MN 5535E `��' <br /> Total Fee: <br /> Main: 952-249-4600 ax: 952-249-4616 www.ci.orono.mn.us <br /> This application form ust be completed in full and all required information must be submitted. <br /> In omplete a plicatio s will be retu ned. (Please print) <br /> GENERAL INFORMATION: s.359Ol1V -. /�Ven u c- <br /> Job Site Address: Lt. I B p-t- L.\ i t �� NCi ti WI v e, I-\ &' < ,— <br /> Will this be a Parade of Homes, Remodelers Showcase H 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 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: ��c�„.... 4V1tit� L-44b-rrtia ; ..l Y\.C. <br /> State License# Z.0(p3 4101 Expiration Date: .- /..5 i f 1 3 <br /> Phone: -1(3.1- 41S - 4g7.c.;, (office) "1 to3 - 7_47_ - -I 30 I (cell) <br /> Mailing Address: 4-loo - i Cit : 01"Q',......4, ZIP: s 5 3=�7 <br /> Contact Person: -R-Q- c\.I AG`— Applicant is: ontrac o / Homeowner (circle one) <br /> Email and/or Fax: .dal-Iv ? C e�o , ec,„,a v•v5t�, ,-hos 1 C_Ar ,, -76„b i 4-iq (4-t Z.. 1 <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: 411,-1 vls 4-2.--. 1,- p✓U':;_Si nc,,, <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> 'New Construction gi,Single Family with ff.Residence <br /> ❑Addition attached garage Garage/Accessory Bldg. Xt 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&permits. ❑ Industrial ❑ 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.orq <br /> Estimated Construction Valuation (excluding land) $ jSi, — <br />