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" � ` � �-� �a�,c ed <br /> City of Orono I����✓� ����-���� zdag �asa9 <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �Z��J �l�J <br /> �j,O,�.O PO Box 66 <br /> O 4 Crystal Bay, MN 55323-0066 Date received: r� v�� � G <br /> ��'� Received b � � <br /> � ��� ���� � StreetAddress:' Y� <br /> ti 2750 Kelley Parkway Plan r�. ' : '� J d,j. � <br /> �l � ����G Orono, MN 55356 <br /> 9kESHo4 <br /> - Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orona.mn.us <br /> This application form must be completed in full and �ll'required information must be submitted. <br /> Incomplete applications will b�returned. (Please print) <br /> GENERAL INFORMATION: � <br /> Job Site Address: 3 31 S Cii2,a�f��-� �,���,�.i� <br /> Will this be a Parade of Homes, Remodelers Showcase Home o o#her Display Home? Yes ❑ No <br /> If yes, a special event permit is required with Police Department and City Council approval 0 c�'ays�prior to the event. Shuttle bus service will e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted vents 'll not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �;ti-�iZL.�� C�iD� (_c� � <br /> State License# ` �, '3S Z S E iration ate: 3 -- I- Z�f D <br /> Phone: �a� Z- �S�]- 7� office) - `�c� � /4 Z cell) <br /> Mailing Address: 5 U�O " 3 /z� i�v�. N� Cit : ' � � � �"" ZIP: SS 7 <br /> Contact Person: 5�� L.,�cr��7- Applica is: Contract / Homeowner (Circle One) <br /> Email and/or Fax: - Z c� <br /> _ � <br /> PROPERTY OWNER INFORMA�fi�N: <br /> Name: L 1-�t��ze-�"� ,,-rn C� � <br /> Phone (day): �, Z- 3 3 - �3� 'Zt� <br /> Address: �p �3 f2' /�UE; �/� Cit : Y����?fl ZIP: .S� �/ � � <br /> Emailand/orFax -5� cl� � C�' Cr-f��lzit�Czi��J � r�f'� <br /> ARCHITECT/ ENGINEER IN RM�TION: <br /> Name: j�� � p '� �ILC.�-(/�C"-� <br /> Phone (day): Z- 3 Z�-- 7�(� <br /> f��lress: �'� � T 3� 'U"E , ; Cit : P� vL!%7f ZIP: 5S¢�7 <br /> Emaif'�r�d/or Fax: �J./U Vvv -t1�G i���-j 5 � �i2 <br /> ,_.-� <br /> � <br /> PROJECT IN MATION: ' <br /> 1. Type of Project �\ . Propose 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> �,New Construction � ingle Family with �,Residence <br /> ❑ Addition �� ktached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building ❑ Siilgle Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial �Private Sewer <br /> ❑ Other: (specify) ultipl Family/Condo ❑Warehouse <br /> ❑ P�c ❑ Storage ❑ Public Water <br /> **Any earth movement may require ❑ Comm ial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial �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) $ f � ��J� � pp p ,d <br /> Last Updated: 6/22/2009 <br /> - 19 - <br />