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? <br /> �f� �a <br /> City of Orono ,,�� 90 �� <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: O��/O-�,S/l <br /> 'gi►�.� PO Box 66 <br /> � � Crystal Bay,MN 55323-0066 Date received: �v aL�d <br /> a a StreetAddress:' Received by: �'Jr <br /> �'� " ���' 2750 Kelley Pa�lcway Plan review fee: �,;! '.J'�.� <br /> t'9$�SHp4�' 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 information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: />7,Q S�j��ia Do� � Gc����'Z���- t'��'� ✓��3�/ <br /> Will this be a Parade of Homes, Remodele Showcase Hom or oth r Display Home? ❑ Yes ❑ No <br /> If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. ShutUe bus service will be <br /> required un/ess applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ��/'i�tr� '�f���"S <br /> State License# Expiration Date: <br /> Phone: — — �/ 2 o�ce �j ,�— � —��c,� cell <br /> Mailing Address: / 7 S �,��,, Cit : � � ZIP: .5'S <br /> Contact Person: ._Sn,�-,�_ Applicant is: Contracto / omeowner �cir�ieo�e> <br /> Email andlor Fax: <br /> PROPERTY OWNE�FORMATION: <br /> Name: ���i��� �r�t�"� <br /> Phone(day): G/� .�yd�-i�lL;{ <br /> Address: ,.5'a�>>t �S � �✓- City 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& <br /> ❑New Constructi n Water Supply <br /> y� ❑Single Family with ❑Residence <br /> �Addition — ,c(/1�,� attached garage ❑Gara e/Accesso Bld <br /> ❑Accesso Buildin 9 rY 9• ❑Public Sewer <br /> �Y g ❑ Single Family with �7(Deck—rc�%kCiri y^l� <br /> ❑Relocation detached garage ❑Office/Commerci� ❑Private Sewer <br /> �}Other:(specify) �`cD/r�CiR� r.,��rfh� ❑Multiple Family/Condo ❑Warehouse <br /> � "�tt�L ❑Public ❑Storage ❑Public Water <br /> *"Any earth movement may require ❑Commercial ❑Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other:(SpeCify) <br /> 18202 Minnetonka Blvd <br /> Oeephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.o <br /> Estimated Construction Valuation (excluding land) � d���. �� <br /> Last Updated: 9/29/2009 <br /> - 17- <br />