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. ��� �D <br /> City of Orono ,,�` <br /> Building Permit Application � 90 �� <br /> for New Structures or Additions <br /> Mailing Address: Permit number: O�C>/O-�S/l <br /> O��.�0 PO Box 66 <br /> Crystal Bay,MN 55323-0066 Date received: � aG�� <br /> a � ;�' �, Street Address:' Received by: /1'f� <br /> �c� " n ��F 2750 Kelley Parkway Plan review fee: �,.5.� <br /> r9kESFI�g'� 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: r J �... /�'I�-� ,>.�.��`7/ <br /> I ��,� Sh��/,� �va� �� % l-� ���z<< <br /> Will this be a Parade of Homes, Remodelei Showcase Hom or oth r Display Home? ❑ Yes ❑ No <br /> If yes,a special event permit is required with Police Deparfinent 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: _�5i'ii�r� �t��r's <br /> State License# Expiration Date: <br /> Phone: - �/ ;,� office �� - - � --s�y cell <br /> MailingAddress: /�> � �-,, 1 /"� � Cit : � G �/,.L ZIP: .SS r <br /> Contact Person: _5�;.-�-��_ Applicant is: Contracto I _,Of1120Wf1@f (CircleOne) <br /> Email and/or Fax: <br /> PROPERTY OWNERfII,?FORMATION: <br /> Name: fi�'��.� ��-�rr.3 <br /> Phone(day): G�� >yQ._�.{{�;{ <br /> Address: ,S'a��,� �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 ConstructiQn Water Supply <br /> ❑Single Family with ❑ Residence <br /> �Addition - ,t//,��� attached garage ❑ Gara e/Accesso Bld <br /> ❑Accesso Buildin g rY 9• ❑Public Sewer <br /> rY 9 ❑ Single Family with �(Deck�-i�`�/kC�i� y^l� <br /> ❑ Relocation detached garage ❑ Office/Commerci� ❑ Private Sewer <br /> p Other: (specify) /'�/�/aC i n,, e X,r�Sn� ❑ Multiple Family/Condo ❑Warehouse <br /> �«�� ❑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 /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �f�/ J� <br /> Last Updated: 9/29/2009 <br /> - 17- <br />