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\ � 33� g' <br /> � Cit of Orono �� <br /> Y <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: �Q��—�D � <br /> ��,�,�. PO Box 66 <br /> Permit number: <br /> �� Q Crystal Bay, MN 55323-0066 Date received: <br /> 'i ��� � <br /> 1`a � �t� ` a.�, 1Q'� 1 Street Address:' Received by: <br /> ���' ��, �� 2750 Kelle Parkwa <br /> \c�L „l x• p Y Y Plan review fee: <br /> `�E"'�og/ Orono, MN 55356 <br /> , , s_x , � �� !. �� ' <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: � ��� � ��;�����1 }�,,� r� �j ��� ���I <br /> Will this be a Parade of omes, Remodelers Showcase ome or other Display Home? ❑ Yes No <br /> If yes,a special event permit is required with Pofice Department and City Council approval 60 days prior to the event. Shutfle bus service ill 6e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPI ICANT INFORMATION: <br /> Name: __�_� h,�rru CvunS <br /> State License# Expiration Date: <br /> Phone: `] ��_ a y�-728 7 (office) , (cell) <br /> Mailing Address � 3 QO - :I r��d� Cit : ZIP: _553� <br /> Contact Person: -�j G.e.r,-., Cv�nS Applicant is: Contrac or / Homeowne , (CircleOne) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION� <br /> Name: � �1-��r�,I ���5 <br /> Phone(day): c fj: �- a '` k, <br /> Address � "� � Cit : � � '�t� ZIP: r��i <br /> Email and/or Fax ��.Q �' <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: '�'i,c,-��= 51.� r �ornc /Jc.y�� <br /> Phone(day): �j 5� . 3.� 7 - �y o a. <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 /> 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 <br /> Other: s ec ❑ Private Sewer <br /> �-} ( p ify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public Storage ❑ Public;alVater <br /> *"Any earth movement may require ❑ Commercial �Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑ P ' ate Well <br /> Minnehaha Creek Watershed District(MCWD) (�] Other: (Specify) <br /> 18202 Minnetonka Blvd G�� • ,. � <br /> Deephaven,MN 55391 <br /> �� <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ;'��f�l �'�' <br /> , I � � „ . .. � <br />