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��, a(�o�,a <br /> � � <br /> � � � � a�� <br /> City of Orono <br /> Building Permit Application �� <br /> for New Structures or Additions 57�-?s <br /> Mailing Address: Permit number: oZ0/D-U(,�5 <br /> '¢0.� PO Box 66 <br /> Q � 0 Crystal Bay, MN 55323-0066 Date received: �l /O <br /> ���?,c�„�, <br /> � ��'- `<�?:> �. Street Address:' Received by: /�f� <br /> >� �� �, .35-ri. 29 <br /> �� � ' �''�!'�� G� 2750 Kelley Parkway <br /> t9 ` �`�� Orono, MN 55356 Plan review fee: <br /> 'tEsxo4`' oZp�p—D G��j <br /> Total Fee: <br /> Main: 952-249�600 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. (Please print) <br /> GENERAL INFORMATION: � ^ \ <br /> Job Site Address: �3� �-k ��. �r�;,�� � Uv <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [�No <br /> !f 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 /> requrred unless applicant demonstrates sufficient on-site parking is available. Non-permrtted events wilf not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �' �� <br /> State License # � '3$3� Expiration Date: '�� �2 <br /> Phone: Z.- �2Lc- g-` (office 3-'z$(�- Z Z`� cell <br /> MailingAddress: Z�u.— �,�;�1� S , Cit : (�,� �� Z�p: SS3�O <br /> Contact Person: �S �e.S orC Ar� � Applicant is: Contract r / Homeowner (Circle One) <br /> Email and/or Fax: �� �.S o� �,�ex �„� <br /> PROPERTY OWNE INFOR�ATION: � <br /> Name: 1 ,;, � J��; �e1z�- � <br /> Phone (day): `jSZ- ��2- 11$ <br /> Address: �(3S �� < �. Cit : �.,nc, ZIP: ��3�0 <br /> Email and/or Fax N� <br /> ARCHITECT/ ENGINEER I,N�FORMATION: <br /> Name: ��z�"oG• �c� ��S '�c <br /> Phone (day): SZ-S2cv�- $�� <br /> Address: 23y,� ;Q/s . City��v�c ��� ZIP� �.3.�.� <br /> Email and/or Fax: �-�,��s :� p�.�� e.��,�p�G,`„ , <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/Accessory Bldg. [�Public Sewer <br /> ❑ Accessory Building ❑ Single Family with �Deck <br /> ❑ Relocation �b� �k� detached ara e <br /> ther: (specify) ��� g 9 ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage �Public Water <br /> �*Any earth movement may require ❑ Commercial �Oth r(specify) <br /> MCWD review& permits. ❑ Industrial I�-� ❑ 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.or <br /> Estimated Construction Valuation (excluding land) $ 3g�p� <br /> Last Updated: 9/29/2009 � <br /> - 17- <br />