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' � City of Orono � <br /> ' U� �t'ml <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: • (? E >•- .0 �i <br /> QA, PO Box 66 <br /> � `v� Crystal Bay, MN 55323-0066 Date received: J`J <br /> Street Address:' R <br /> �� ,� 2750 Kelley Parkw , �1 p�a iew e: ��P <br /> L~ Orono, MN 55356 y� �`�'��� �� � <br /> t�KESH��� Main: 952-249-4600 Total Fee: � � � <br /> Fax: 952-249-4616 wv.���rJ.ci.oro�o.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: 2oL� (� „� o( ,��,, p � .J S<35 ) <br /> Will this be a Parade of Homes, Remode ers Showcase Home 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 I 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: 3 -�,�-.. -• ��l�� �c�c.,� <br /> State License# Expiration Date: <br /> Phone: (cell) (L 67o S'D�-f (office) <br /> Mailing Address: ZoZ4 SG►�� � Cit : 8r�y..ti � Sr39/ <br /> Contact Person: C� Applicant is: Contractor / own L- (Cir�le One) <br /> Email and/or Fax: Qe�.,(�_c,.,,,,�o�r� �,,,-�n• ,�,,•-,c.--, �-� c„�,., bt,v►�am�n. ('_� �C..i� q <br /> PROPERTY OWNER INFORMATION: J ahh - � ` �-1�hw � �� � <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: ��-�Mi, �e�P/f� — �vJsa C.o✓i J�l���5 � �1�-• <br /> Phone (day): �1 SZ- °l '�4� 71 3 7 <br /> Address: 702� �ow,a���.� c,�f � City: ��.;�� ZIP: fr �3� <br /> Email and/or Fax: ('��So '�a (a c,o�,�. �-I- <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> FR�JECT INFORMATION: Description of project: (L�.w�.o�� a,n� (k,p�h� �a�} ti o��� An� J�PJ <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑ Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ❑ Public Sewer <br /> �ccessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Septic <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) (Compliance certificate <br /> ❑ Public 4-feet or greater may be required) <br /> *"Any earth movement may require ❑ Commercial � Storage <br /> MCWD review&permits. ❑ Industrial Warehouse ❑ Public Water <br /> Minnehaha Creek Watershed District(MCWD) (5�Other: (specify) ❑ Other(speCify) <br /> 15320 Minnetonka Blvd; Minnetonka,MN 55345 S�I►�49 ❑ Private Well <br /> Phone: 952-471-0590 / Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Constructic�n Valuation (excluding land) $ � '�. n6 U <br /> -T_ <br /> Packet Last Updatea. January 2016 <br /> Page 21 <br />