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� ��� <br /> �' � Cit of Orono � .7s <br /> �� y / �� <br /> Building Permit Application , � <br /> for New Structures or Additionsi <br /> --� Mailing Address: ��G7 � OQ�'i�9 <br /> �,�\ PO Box 66 <br /> Permit num er: <br /> � �Q�� Crystal Bay, MN 55323-0066 Date received� �z O/ <br /> A� <br /> � 3"',� <br /> a �'� ,,l Street Address:' Received by: <br /> ��'.y <br /> �'�,n � j� G�`S 2750 Kelley Parkway Plan review fee: �lP� $ <br /> �'��SHo�`'�� Orono, MN 55356 a0 _ �� <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 pnnt) <br /> GENERAL INFORMATION: <br /> Job Site Address: � ' - ��ry�� � <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 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/APPLICANT INFORMATION: <br /> Name: L�'-f'j ('�t,�t1M/ I�l�GL�,c� <br /> State License# Expiration Date: <br /> Phone: ��1..�7�- '��Z� (office) (cell) <br /> Mailing Address: Cit : �' ZIP: �'33 <br /> Contact Person: ��� j���,� Applicant is: on / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �Zck��G�I��G+�C;v� �'Y�C.�(:�t�� <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �'Q,r?�}'�l'l�5df�.��1 <br /> Phone (daY)� �l?32�3 �5y-� , �192ZG���I IU� <br /> Address: ��(U� IMI ��("��i., �3�,J1,(� City: j�t'i�ph� ZIP: �j 7,�� <br /> Email and/or Fax: a,�,�,�yk��� h���� ,�m <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 /> Q 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 0 Other(specify) <br /> MCWD review&permits. ❑ Industrial �(1)6�rY1 ❑ 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 (exduding land) $ (� <br /> Last Updated: 9/29/2009 <br /> - 17- <br />