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y <br /> g 7 9, g',U <br /> City of Orono 2 <br /> Building Permit Application <br /> for New Structures or Additions e 5Crow '�� <br /> Mailing Address: Permit number:D`Y ,;,erg—0d 3 i 7 <br /> A, PO Box 66 p <br /> /� �`1ti\oro, <br /> Crystal Bay, MN 55323-0066 Date received: <br /> r 3-/Q-/p <br /> 14- <br /> { Street Address:' Received by: <br /> ( j 2750 Kelley Parkway Plan review fee: % . 302 <br /> �0 , Orono,MN 55356 g01?-.°63)4i <br /> ke i/ Main: 952-249-4600 <br /> Total Fee: <br /> Fax: 952-249-4616 www,ci.orono.rnn.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: <br /> Job Site Address: 3 S SS- CRwy S+-A- P L . <br /> Will this be a Parade of Homes, Remodelers Show ase Home or other Display Home? ❑ Yes kiNo <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: E \(Ae . <br /> State License# C. 6. C)9 Z 3 Expiration Date: 2-,9 'A <br /> . <br /> Phone: (cell) 6 2.-7 c.) v 3 -1kl (office) <br /> Mailing Address: 3c" N> TKA N icAtn, �( . t 1l Q City: M ,ti��QLZIP: 5 C 4 ti/ <br /> Contact Person: Q(+r'q� Z(-1 'k Applicant is: / Homeowner (Circle One) <br /> Email and/or Fax: C 0N-A- %c-k- Ca)L LkB \VC\-LC ME , C <br /> PROPERTY OWNER INFORMATION: <br /> Name: <--1'3 "\Q. • <br /> Phone(day): k 2-70 ' <br /> Address: 5 t,' V\ t'1 . k(ci City:PYPA,DtJt ZIP: S S 111--t( <br /> Email and/or Fax C(;)144 A i-k CAA 13e 1r1C\-1 7f a.. CO(`n <br /> ARCHITECT/ENGINEE INFORMATI N: <br /> Name: -i--‘2N/G ORA H-i OCI ‘400 me c-3S ig /✓ <br /> Phone(day): 61'2 2� 5_2_____-12._ <br /> ,.{ >L <br /> Address: 3tQO Q �P kS t Pe�/I 0 i\\. 5 . City: ,. •\-. \,S, (4IP: - 41 2k <br /> Email and/or Fax: S- 1- 2 Q;P+ -k-1 i1c\Ca, Cy's'N A l . Co r1 <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> New Construction L Single Family with 0 Accessory Bldg./Garage <br /> Addition attached garage ❑ Deck Public Sewer <br /> ❑Accessory Building LI Single Family with Office/Commercial <br /> ❑ Relocation detached garage Residence ❑Private Sewer <br /> ❑Other:(specify) ❑Multiple Family/Condo Retaining Wall(s) <br /> ❑Public 4-feet or greater yr Public Water <br /> **Any earth movement may require ❑Commercial ❑Storage <br /> MCWD review&permits. ❑Industrial ❑Warehouse ❑Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other:(specify) ❑Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or4 <br /> Estimated Construction Valuation (excluding land) $ 2.2 5 . <br /> 00 <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />