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r . ' � <br /> • `�►� � _�� � � <br /> City of Orono � ' '�� ���`° ,� ` <br /> Building Permit Application � �\� <br /> for New Structures or Additions � <br /> Mailing Address: Permit number: �D/v�- do 73 <br /> O�,D,�.O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: ������ <br /> ,� a Street Address:' Received by: ��' <br /> �'.F, y GtiiS' 2750 Kelley Parkway Plan review fee: . �f�� <br /> t9AE3H��'� Orono, MN 55356 � <br /> - Total Fee: �/�, / � �1 Vt <br /> Main: 952-249-4600 Fax: 952-249-4616 www ci ororo mn us �P �� <br /> This application form must be completed in full and all required information mu e su mitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 2� � �: S,-�r�k� Lti��;� _ <br /> Will this be a Parade of Homes, Remodelers Showcas 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 event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICA T INFORMATIOI�: <br /> Name: �J� u- c�--e� s <br /> State License# L p � � v Expiration Date: 3�3 c -Zoc 3 <br /> Phone: 6�2-�6 -Z2 Z office (cell <br /> Mailing Address: ?.� re.��(c � �� Cit : �to ZIP: <br /> Contact Person: �T.;� ,,,,,- �- Applicant is: ontracto / Homeowner (Circle One) <br /> Email and/or Fax: ct�,5- �-U� �_' aef (3 G��.v . �,cx-�- <br /> PROPERTY OWNER INFOR�ATION: <br /> Name: �e� �u f�� � <br /> Phone (day): �6U �- 0� 6 7 v� <br /> Address: c2 �b�' Sh�- ,�i.c.)cx� �C�, City: ���C.9uU ZIP: � �.� 1 <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATIONj• n <br /> Name: �;�/s2�.�� (.rzJ�-� r✓� S��t.�'i^ CU . <br /> Phone (day): 6 3 - y6 y - � � y �p <br /> Address �Zou �,.� J.;-��./ �� Cit : �f �i �h-��� ZIP: S_5 yy7 <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction �Single Family with �'Residence <br /> (�Addition attached garage ❑ Garage/Accessory Bldg. [L]-�ublic 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 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 /> /� .-�._ <br /> Estimated Construction Valuation (excluding land) $ l �� ls�� <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />