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� I/^:� ��� <br /> V�' 1 ��?- �, � <br /> City of Orono � <br /> Building P'ermit Application �" ��'��� <br /> � �l <br /> for New Stru�ctures or Additions <br /> �O=_.�' MailiPO Bo�r66. Permit number: �l� � <br /> �V Crystal Bay, IVdN 55323-0066 Date received: � �a / <br /> , o .�� o <br /> �� � y: <br /> ��,a +�''�,� '� � , Street Address:' Received b <br /> �'�, � �,�"�,� Gti / 2750 Kelley Parkway Plan review fee: <br /> \�E������ Orono, MN 55356 <br /> ,,____��04 0�0//-00��7 <br /> -----' Total Fee: � <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us 33g•33 <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete appfications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �7�C� �c�X Si�-,L.iZ� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �-fdo <br /> If yes,a specral event permit is required with Police Department and City Counci!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 wil!not be alfowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: O`f%G�N���S �v�G= � <br /> State License# Expiration Date: <br /> Phone: '�,S 3 - ���_ �J� � (office) G/� - -7G/�- �>,a-J--1- (cell) <br /> Mailing Address: �/3}-/ ��r.� �,.�r ,�.. CitY: ,��1,�,��.d,�:#ZI P: �S�i�s <br /> Contact Person: �,,`��L Applicant is: ontrac - �/ Homeowner (Circle One) <br /> Email and/or Fax: �ti,� �,¢�L�,�,,�--,3�C,�c s i�-C"-�.��r"l <br /> PROPERTY OWNER INFOR�VIATION: <br /> Name: ,!��4�J;:� /`�i�-�N S� <br /> Phone(day): <br /> Address: �5'Llv /�'�� �,�t City: ��,r-�U ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <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 8� <br /> New Construction Water Supply <br /> �� ❑ Singte 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 /> �-6ther.(specify) ����oJ.v� �z ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> *"Any earth movement may require ❑ Commercial '�flther(specify) <br /> MCWD review 8� permits. ❑ Industrial <br /> ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other. (specify) � Gi2v✓�v� ���(� <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 �� U <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ��5��� <br />