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♦ <br /> � , <br /> 1 <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions 9o�,7s <br /> Mailing Address: Permit numbera��0— ���O '�f <br /> g.,�,� PO Box 66 <br /> 0 �� � <br /> Crystal Bay, MN 55323-0066 Date received: �/ /� <br /> a � �� Received b I Vl.� <br /> ��;` s. Street Address:� y� <br /> `S� ' 9 <br /> �n ' � � 2750 Kelle Parkwa <br /> � , �i�,.� �� Y Y Plan review fee: �.�' ,�l <br /> '9.gESHp4�' Orono, MN 55356 �,1,� <br /> o�lo-O D <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: wS� ��2��,�t� j�,2 _ <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [�No <br /> If yes, a specral event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking rs available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: _1 oti�t fV1 AJJ�-(s-���,�-T— <br /> State License# ��..p3��, jC�� Expiration Date: --31 - 'Zp� � <br /> Phone: t2-55 - �1�l� office cell <br /> Mailing Address: ' 3 7,��• �,�;,�� l�;Z_ Cit : ZIP: "3y� <br /> Contact Person: �01.UJ C� C�r.,actL Applicant is: C tracto / Homeowner (Cirde One) <br /> Email and/or Fax: ,SuLut•1Np(� �� �N�,�,M,��q ,.�Mcnt— C�/L► <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��M 13��-�r�� ,= �M --�- '�F�•-r,a �C v.�w,,ti-� ,. <br /> Phone (day): �b� —�,z>`1 -21�1 <br /> Address: ��c5;. SHnS�-�L� : ��2 - CitY ���2Ayr� ZIP: �S"3`=� ( <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ��;`�� <br /> Phone (daY)� �`�2 - `��I- iso�� <br /> Address: ,�t�;,� �,!4Y��,4�A 1=s L V� Cit :�r- L.�,�r�s %��' ZIP: -Cj��( � <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal & <br /> ❑ New Construction Water Supply <br /> ❑ 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 <br /> ❑ Other: (specify) ❑ Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "`"`Any earth movement may require ❑ Commercial ❑ Other(specify) p <br /> MCWD review&permits. ❑ Industrial at-t,1� � `�r,�,��...► (c�;.��� ❑ 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 tand) $ --��j��� <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />