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� <br /> 4 <br /> � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: dld-lJL3 <br /> Og,�,�0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: /D <br /> .� ,�` �, StreetAddress:' Received by: <br /> �'�� � � ����' 2750 Kelley Parkway �� ��/Z��� Plan review fee: ��� � � <br /> `��'Esxo4`' Orono, MN 55356 <br /> c�0 C'j- 0 D3�J` <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: Zl 7Z Slt��y�ooc� /���G� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> If yes, a specia/event permit is required with Police Department and City Council approval 60 days prior to fhe event. Shuttle bus service will be <br /> required unless applicant demonstrates suffrcient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Z�� y��o�� �s i�,c <br /> State License# 2a 6 3� g zg Expiration Date: /V��r� zor� <br /> Phone: _2g�-Z q o office cell <br /> Mailing Address: � • e;,� 64�,� Cit : o � ZIP: �533 <br /> Contact Person: a�,4ce Ue��.r Applicant is: ontractor / Homeowner (Clrcle One) <br /> Email and/or Fax: -,c w�d�i,,eas�Oul I r2 (� av�,co� <br /> PROPERTY OWNER INFORMATION: <br /> Name: STev� �ov�� <br /> Phone (day): 95�- 92 S- 5 0 7.S <br /> Address: 2� » S�Qo��u,av�, City: Deo�O ZIP: 5.53�7 f <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ,�OS 1�v�C1�:�ec-�-S <br /> Phone (day): 6l Z- 81 �' - `?6=�� <br /> Address.: Cit : � n�o�fl� ZIP: <br /> Email an`d/or Fax: IrS i�I� ;rw C'sw� C�s�, ,v�'� <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 ❑ Garage/Accessory Bldg. � Public Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ 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) $ �S 5 �oo, c�o <br /> Last Updated: 9/29/2009 <br /> - 17- <br />