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City of Orono <br /> �' Building Permit Application <br /> � for New Structures or Additions <br /> Mailing Address: � _ <br /> �0,�. PO Box 66 Permit number: •� j "-,`) � <br /> � �. 0 <br /> Crystal Bay, MN 55323-0066 Date received: a7 /4� /-�-- <br /> � �'�m-�'` �, Street Address:' Received _ _ � <br /> �,'�'�, ��' 2750 Kelley Parkway Plan re w fee: �' • Zr� �/ <br /> �tg�o�.'�' Orono, MN 55356 � <br /> _ �24; <br /> '-- Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: � �N� <br /> Job Site Address: <br /> Will this be a Parade of Homes, Remodelers S ow a e Ho e o other Display Home? ❑ Yes o <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 I APPLICANT INFORMATION: <br /> Name: �yTpN t ��cDnl <br /> State License# Expiration Date: <br /> Phone: qs',� y 7� �,,����^ (office) (cell) <br /> Mailing Address: Cit : ,,.}U <br /> Contact Person: _S'�}M[.^ � Applicant is: Contractor / omeowner �c�r�ie o�e� <br /> Email and/or Fax: j J„„ �� f e_ S3 � �o ;,,��,,,�.L <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone(day): q . , � <br /> Address: Cit : c� N ZIP: ' 6 <br /> Email and/or Fax � ,� Q � �� ,�� ? �Tr��� �1.C2•� <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& <br /> ❑ New Construction Water Supply <br /> ❑ Single Family with ❑ Residence <br /> ❑Addition attached garage ❑ Garage/AccPssory Bldg. �j Public Sewer <br /> ❑Accessory Building �Single Family with �Deck <br /> �Relocation 1 detached garage ❑ Office/Commercial ❑ Private Sewer <br /> Other: (specify) 7D 4Z-W� ❑ 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: (SpeClfy) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m i n ne ha hacreek.o <br /> Estimated Construction Valuation (excluding land) $ �; ��(�: (�D <br />