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� � <br /> City of Orono � <br /> Building Permit Application 5, �D�.`� <br /> for New Structures or Additions <br /> Mailing Address: <br /> .�0� PO Box 66 Permit number: p��!�j"� <br /> Q Crystal Bay, MN 55323-006 Date received: � �3 <br /> StreetAddress:' Received by: <br /> 2750 Kelley Parkway �a • g'9 <br /> y� � � ' Plan review fee: dO/3 � �'�� 7 <br /> c,` Orono, MN 55356 <br /> t'9kFsy0�� Main: 952-259-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.rnn.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: �?j�� � ( � �� ,� � v �- �-��� �- <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [�-Pdb' <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 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: �-O v�yr_� �o��S <br /> State License# ���(S'�] Expiration Date: <br /> Phone: cell 6� —�7�{L—��� office <br /> Mailing Address: (olt� � �s a v� e wt �✓ Cit : -c�l :� IP: � S �-2� <br /> Contact Person: � A plicant is: ctor I Home wner (Circle One� <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �rov�y�� �w��S <br /> Phone (day): �! -1`l( -�Dlo `� <br /> Address: '�ty: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INF''" <br /> Name: � \ <br /> Phone da��`� <br /> � <br /> Adc' y� -�j�•� �/ \ ZIP: <br /> Em� �1' � � C6Cj i`'1 <br /> � . �j�'',\�� <br /> PRO, � �� l C ` " �• � <br /> 1.Typt ) Q ?� �� �1� � i� �' Sewage Disposal & <br /> � ' � � Water Supply <br /> New � � <br /> . � �� � � � �� � <br /> ❑ Additi� ��� , `� � 'ic Sewer <br /> ❑Acces: ��� •a, <br /> ❑ Reloca� ���l �' `�iv e Sewer <br /> ❑ Other. (: �v , � � <br /> � � cQ� Public Water <br /> '*Any earth � <br /> MCWD revie� ` 0 ❑ Private Well <br /> Minnehaha Cref � �(�� <br /> 18202 Minneton! � �r <br /> Deephaven, MN �� <br /> Phone: 952-471-(. <br /> Fax: 952-471-068: • � <br /> www.minnehahacre <br /> Estimated Construction Valuation (excluding land) a �-�� J O(� <br /> Packet Last Updated. 04/19/2013 <br /> Page 22 of 23 <br />