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• •� <br /> �,,`�(�' \� <br /> �� �c�' City of Orono <br /> ��`�' Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: GV�'O 2� <br /> g►�,� PO Box 66 <br /> 0 Q�', Crystal Bay,MN 55323-0066 Date received: �j� <br /> � 1 �• rj'(� /Zt.�D Street Address: .��,,, � („�, -► Received by: <br /> � ��' � D Q 2750 Kelle Parkwa � � �. <br /> � Y y � L���, � Plan review fee:Cc�() elj Z� �1 =p,f� <br /> �gESAo�`�°' Orono, MN 55356 � pF <br /> Total Fee: p� /'�,Z5 <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: � `j <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> lf yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service wil!be <br /> required un/ess applicant demonstrates su�cient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �Jl�CL�� M�'t�(L1�v� <br /> State License# Expiration Date: <br /> Phone: �Z— 'Z..�- --� office 2 - � — o cell <br /> Mailing Address: w, ��c,� Q Ci : — <br /> Contact Person: Applicant is: Contractor / omeowner �ci��ie a,.� <br /> Email and/or Fax: -�M �r p �,�µ,��� Cc.�n <br /> PROPERTY OWNER INFORMATION: <br /> Name: � �'E,�.� .�J�lL�V� <br /> Phone(daY): C�l2 — 4��� — (���G � <br /> Address: i-1'�7 Z \,.� . A�M QO City• ����,�}-Q� ZIP• zj �`� <br /> Email and/or Fax 1�RQ���q (� �,��L� C�M <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ��v� \lo �.�,—RUM <br /> Phone(day): �„lZ_ z.��0 -�1 N Gb <br /> Address: Ci . Z�P. <br /> Email and/or Fax: p�}vL.vo �s:a .�n C� A c��. GOM <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8 <br /> Water Supply <br /> ew Construction �ingle 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 <br /> ❑Other: (specify) ❑Multi le Famil /Condo ❑Private Sewer <br /> P Y ❑Warehouse <br /> ❑ Public ❑Storage �Public Water <br /> "My earth movement may require ❑Commercial ❑Other(specify) <br /> MCWD review 8 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) $ .�'�' �= <br /> - 18- <br />