Laserfiche WebLink
^ � � �� � <br /> � � ,o � � <br /> City of Orono � <br /> Buiiding Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: dl�-d6 <br /> 'g+�.�j PO Box 66 <br /> Q 0 Crystal Bay, MN 55323-0066 Date received: /O <br /> ►� ;•.�. � StreetAddress:' Received by: /L-L/C <br /> ��t � " ��`� 2750 Kelley Parkway �� ��/Z��� Plan review fee: ""'3�7,J � <br /> �'kESH04�' Orono, MN 55356 C��'lIZ3 <br /> do a_ oo3.�S <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: 2�7Z S��r�y�uooc� ���G c� <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 wifh Police Department and City Council approval 60 days prior to the event. Shuttle bus service wiB be <br /> required unless app/icant demonstrates su�cient on-site parking rs available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ��� d��o��- l��es ��,c <br /> State License# 2d6 3� g g Expiration Date: /l�ttia��, ao,� <br /> Phone: �� _Zg�_� q d office cell <br /> Mailing Address: y�o L�-kP��;�w �. City��'o,�c, �y ZIP� 5533� <br /> Contact Person: ctqce UP��L�.r Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: -f�„��d�i,,e�s I�u; I r2 (� av<.co� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �Tev� �o�r� <br /> Phone (day): �SZ- 2 S_ d 75 <br /> Address: 2� » sl,Q��u,��,c� Cit � (�eo�p ZIP� 5.53�r� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ��.5 J�v�c1�:�-Pc�-S <br /> Phone (day): 6�2- gl G� - �6:�� <br /> Address: Cit : � n�o�f'1� ZIP: <br /> Email and/or Fax: ►rS f al� ic�► (�sw� (��s,—, ,vP'i- <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 ❑ Gara e/Accesso Bld <br /> ❑ Accessory Building ❑ Single Famity with ❑ Deck9 ry g' � Pubfic Sewer <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) $ �ys 5 �oo, c,o <br /> Last Updated: 9/29/2009 <br /> - 17- <br />