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� � � <br /> � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: c�' ;`'� '�'�' •� <br /> O�,D,�.O PO Box 66 <br /> , <br /> Crystal Bay, MN 55323-0066 Date received: `7 I�C /�- <br /> ��' � / <br /> ti a '"l'�{ �;= ,, Street Address:' Received �—_ _ _. <br /> c <br /> '�,t ����ti�' 2750 Kelley Parkway Plan re w fee: �� � 1 � �� ' <br /> \.��$xo¢� Orono, MN 55356 _ �,�,� <br /> �_�-=_=.'' <br /> Total Fee: % <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us l ,�,'-j } 7�; <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 /> GENEI�AL INFORMATION: . <br /> Job Site Address: 7 C�/�� <br /> Will this be a Parade of Homes, Remodelers Show a e Home o other Display Home? ❑ Yes o <br /> If yes, a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> requrred unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: �y�TDr� � ��SOtiJ <br /> State License# Expiration Date: <br /> Phone: q,s'�y 7� �"��`� (office) (cell) <br /> Mailing Address: Cit : ,�p ' <br /> Contact Person: S'r�M L-" Applicant is: Contractor / lomeowner (Circle One) <br /> Email and/or Fax: � J� �„ ��� �e_ S3 ��<��n ; c�.�wc <br /> PROPERTY OWNER INFORMATION: <br /> Name: 1� A U7"rin/ t�}�SQ� <br /> -�P.,�--�r--�-. <br /> Phone (day): q_5"�,"� • �7� ��-o"� �S' <br /> Address: � � `7 (, ��/�� � City: t7�p�i� ZIP: S�S`3 6 � <br /> Email and/or Fax _ /�1 y�� �� ��~ '� ��r„���6, ����,.1,, <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <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 8� <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 1 J detached garage ❑ Offce/Commercial ❑ Private Sewer <br /> Other: (specify) �O 4�("J� �C ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review 8�permits. ❑ Industrial �rivate 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 tand) $ �, �>Q(� . QD <br />