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. . �1 � �� � <br /> � � ,o � � <br /> . <br /> ` City of Orono � <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: dld�d6 <br /> gv 0� PO Box 66 <br /> 0 � Crystal Bay, MN 55323-0066 Date received: /D <br /> �, <br /> ����T, <br /> a ��`�j;�,-��` s.i StreetAddress:' Received by: /t-�!C <br /> o;� <br /> �� � �i�"��.� ��� 2750 Kelley Parkway �� ���/Z��� Plan review fee: � <br /> .3 D 7.S `� <br /> t�'kE9H�4� Orono, MN 55356 C,�1C-+�'IlZ3 �� d_ ��3�T <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: Z�72 5����r�y�uooc� /���G� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the even:. Shuttle bus service will be <br /> required unless appficant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ��� �(I�o�7� �,l�r�Fs i�.c <br /> State License # 2p6 3/ S z9 Expiration Date: /V�G���, zo�� <br /> Phone: �� _2g�—� y o office (cell <br /> Mailing Address: y/o Ll�-k vi ei.w {4� Cit :�'o,v�G / <y ZIP� �5��� <br /> Contact Person: ctq ce ve��.r Applicant is: ontractor ,, / Homeowner (Cirde One) <br /> E m a i l a n d/o r F a x: -,���.,����,,�;,s(�,,; I r2 (� av�,co� <br /> PROPERTY OWNER INFORMATION: <br /> Name: STe�� �o�-e <br /> Phone (day): 952- 2 5— 5 0 �S <br /> Address: 2� » Sh4��wc vcP City: Oeo�p ZIP� 5�.3�( <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: �DS �s�h.�Pc�--S <br /> Phone (day): 6l Z_ gl �' — �6�� <br /> Address: Cit : �� n�o�-f�, ZIP: <br /> Email and/or Fax: IrS i df� i�r� C`ew�(�as,—, ti�P'T— <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 ❑ Gara e/Accesso Bld <br /> ❑ Accesso Buildin g rY 9• � Public Sewer <br /> rY 9 ❑ 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) <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) $ ',�S 5 �oo, c�o <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />