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� � L� �-/�-/o <br /> � <br /> � City of Orono <br /> , Building Permit Application <br /> for New Structures or Additions � 37o6.7s p�- <br /> �-- � Mailing Address: Permit number. ��-� � � � �-'�'i<`�'- <br /> /-+¢,�,�. PO Box 66 <br /> � Q� Crystal Bay, MN 55323-0066 Date received: —'��` ��l O <br /> / � <br /> ��.��� , I • Received b � �--�-� ��'-. <br /> ,� r ,� ..r �, , Street Address: _-y�-- <br /> '�,�,��{��� �ti 2750 Kelley Parkway � � �^ ,, � Plan review fee: 2 2L( �7 <br /> � ��� Orono, MN 55356 �" f` ��`��� <br /> 9kEsxo4 <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: �` �7% S �� I�,�� � <br /> Will this be a Parade of Homes, Remodelers S owcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes,a special event permit is required with Police Department and City Council approva160 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICA T INFORMATION: ! �d�l� � <br /> Name: ���/rr-- ��Y► � ^� C_ , <br /> State License# Expiration Date: <br /> Phone: '"7 - 7' - (.3 (office " / - � 9 C>7 �- (cell) <br /> Mailing Address: / t�°�� r>,<s' Cz- y � r. �, City: �7; �� ; ZIP: � <br /> Contact Person: � cr Applicant is: ontracto / omeowner (CircleOne) <br /> Email and/or Fax: ���,{-ii � ����=j;r.-� % i.f�i-,s}/ , C�+-.. <br /> PROPERTY OWNER INFORMATION: <br /> Name: �r�` <br /> ` \r� Phone (day): ,"7!o� .,- ..�r--7 I _c- (d �7 /� � I / <br /> r,\��/ Address: �/�l ��' /�c�vi�-f �/t- ,�-[ U,^ ��+'f' City: ��:s� /`�+/� ZIP: �'�y�� <br /> � Email and/or Fax �..r��r� /,� ai-� �od.� T <br /> ARCHITECT/ENGINEE� INFORMATI N: <br /> Name: O�' .�� ��.���L-� <br /> Phone(day): , /-- � -'� 1 n <br /> Address: � .sl�� �'ro�C-�� Cit : T. �w� ZIP: , //J' <br /> Email and/or Fax: �/� �3�� j(zs <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) -7✓h- , ❑ Multiple Family/Condo Warehouse <br /> ❑ Public ❑ Storage h�Public Water <br /> **Any earth movement may require �Commercial ❑ Other(specify) T� <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'(�U�Q(f G' <br /> � <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />