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. � <br /> City of Orono <br /> � Building Permit Application <br /> � � for New Structures or Additions <br /> � Mailing Address: Permit number: � —(�UC�] ( <br /> O.g,D,�.O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: , �_ `( � <br /> �, .. _. <br /> a ,y s. ; StreetAddress:' eceived by: <br /> '�,�, �ti � 2750 Kelley Parkw ��I a�e(;�p Plan reviewfee: � . g � �/�� <br /> L�kESH�/ Orono, MN 55356 <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 infiormation must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: l�� ���'� �'v�r��s ����' <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No <br /> If yes,a special event permrt 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 /> Name: L�G �j�aoy, �-{�►-�E� <br /> State License# � F�� �,� Expiration Date: 3 3� ?�I�~ <br /> Phone: ��-�'✓-Z "f4��1'—`�4�D`� (office) (cell) <br /> MailingAddress: � l5r5sZ �-tw Cit : �.e.�r�'-�'���;ca-ZIP: �"" <br /> Contact Person: �.4,.�,..�. �a[.s� Applicant is: ontract / Homeowner (CircleOne) <br /> Email and/or Fax: 1��'tt�co� � t..,Ee��d 1���, C�r-�t <br /> PROPERTY OWNER INFORMATlON: <br /> Name: ��� � ���a�-.s:� d..��� <br /> Phone (day): �a� 64=- �"jr..��'".� <br /> Address: �it-�''T� ,.�+Ra •�%�",�a,!� City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> � <br /> Name: �;:-� �v���-'�-- d���"P <br /> Phone (day): <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 �arage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with Deck <br /> ❑ Relocation ,., detached garage ❑ Office/Commercial ❑ Private Sewer <br /> �Other: (specify) ��►a��r�""- ❑ Multiple Family!Condo ❑Warehouse <br /> �,��.;�-���„ ❑ Public ❑ Storage ❑ Public Water <br /> *�Any earth movement may require ❑Commercial (�Other(spec,�Y) <br /> MCWD review&permits. ❑ Industrial M'1��'jt"'�'�'�4'�" �� ❑ 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 /> wvwv.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � ` �'a �""J`� <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />