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� t <br /> City of Orono <br /> Building Permit Application �� '�C <br /> for New Structures or Additions � �� <br /> ;-:_--- Mailing Address: Permit number. �O�� - D U� 7 <br /> +�/ �,�,�\ PO Box 66 <br /> 0 , Q�� Crystal Bay, MN 55323-0066 Date received: -/O-/Z <br /> �� ���' -. �1 Received by: �6 s <br /> `,a y '��:�... s,�; Street Address:� <br /> \`��, �,rt �'tF�� G�� 2750 Kelley Parkway Plan review fee: /7�•58 �c� <br /> \��o�� Orono, MN 55356 <br /> , a7o/ -DDa7 i <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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: l������; �-j,c����;�,_� ���� ��r���� �S ,�C, �� <br /> Will this be a Parade of Homes, Rem delers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> lf 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 /> �'r <br /> Name: �.'-� �`�v i Cr% �r�S Tn.�r j-,Z:�-�. <br /> State License# �� (� Expiration Date: ;-�;j- �t-,�Y <br /> Phone: i, —c- � office (cell <br /> Mailing Address: Z � , City: . ,c��,rc ZIP: .S" <br /> Contact Person: r o r v 12- �,v�y. Applicant is: n ra�r / Homeowner (Circle One) <br /> Email and/or Fax: (�;'S� � Z — C�� <br /> PROPERTY OWNER INF �MATION: ,J��' `�'`v�� l r <br /> Name: , N I ` __��-t�c/ <br /> Phone (day): (�i� ` - ., <br /> Address: � c�t : ���,��:n� ZIP: SS f `"� <br /> Email and/or Fax ' � • � � ' �? �� � ,. r�,--,.-_ <br /> ARCHITECT I ENGINEER INFOR TION: <br /> Name: �� ��?��i��'L;�►<<��� _ <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> ���ee� <br /> PROJECT INFORMATION: I� � � /1 L �rz:;nt - I�c, olA cic�ck�cc:nc� ' "���� Sar��u `��,�s."� ��ck�ZC�.'��:,..--� <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <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 detached garage ❑ Office/Commercial ❑ Private Sewer <br /> �Other.(specify) >f-C`_� ❑ Muitiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> ""`Any earth movement may require ❑ Commercial �Qther(specify) <br /> MCWD review 8 permits. ❑ Industrial I�c�'� IL ❑ 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) $ j� jC <br />