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. <br /> � ` C i ty of O ro n o g � ,� <br /> .�� ��� ► Building Permit Application � <br /> for New Structures or Additions <br /> Mailing Address: Permit number: 0101 I - Dl�� 1 �-- <br /> ��,�,j�\ PO Box 66 , <br /> �Q Q� Crystal Bay, MN 55323-0066 Date received: =�, i 1 � �i <br /> ��r �� '� � Received by: <br /> 1'�a "'�`,'� : a, Street Address:� <br /> �`�',�, � �� GticS'/ 2750 Kelley Parkway Plan review fee: `�� 1 (,' : '._i., <br /> � � <br /> \� j�• ���r � Orono, MN 55356 o2.D//- D�a/l <br /> �'�si�os� <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: f �^ <br /> Job Site Address: l � �U 0 �i�rro��oc�� (�on O �� o <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes <br /> lf yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus se e 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: ���.�-t.... ' �c-Tz,scrcJ <br /> State License# �/,�- ' Expiration Date: <br /> • Phone: �, _Z � � office -r'-� v.�� cell <br /> Mailing Address: (��-� . � �����` City:"Prc.��.��. � ZIP: �5�372- <br /> Contact Person: f G���f Applicant is: Contra,�tor / Homeowner (Circle One) <br /> Email and/or Fax: ��.�., � �ti-r-��-(ZA p�j (,,c,v � „ �e�r.L <br /> PROPERTY OWNER INFORMATION: • <br /> Name: �.-i-���o�- � ��Lc., Q /�L� � <br /> Phone(daY)� � [7 -�GG>()- C��-1-�a i <br /> Address: 1 �, �., f� �.4�(�j•l��gao� City: �i�6rJ 0 ZI P: SS 3`�J� <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Cit : 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 ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Muttiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may require ❑ Commercial Otger specify) <br /> MCWD review 8�permits. ❑ Industnal �1L. <br /> ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other.(specify) �rC��� � <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ Q , p-d <br /> � . ' i - . <br /> , I <br />