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•-�_. <br /> � �� <br /> �- �� <br /> ' City of Orono � (P' � <br /> • • � �� �/��� <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: ' ` �� <br /> ,�} PO Box 66 ��������" �' �—��� <br /> �'�l vO Crystal Bay,MN 55323-0066 .p���-���: ' �- <br /> StreetAddress:' '�$�'��e�'�� ��� <br /> � ,�. 2750 Kelley Parkway p����: . �� <br /> y� L� Orono, MN 55356 ���� _� �9, <br /> �"�kESHo��' Main: 952-259-4600 �p�����; , <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> �..., . _ � �,� �. : <br /> : „ � �P/ease print) <br /> __�,...�.... .� , .,... � �__ y .. , ..._ _� ._ � � <br /> GENERAL INFORMATION: <br /> Job Site Address: /�7do �Sl�r�/��►� �"j�- d►-raM.c, i"�''J 5��9� <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 with Police Department and Ciry Counci!approva160 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates s�cient on-site parlcing is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: ,N � f7�o�.,*S LL-C- <br /> State License# �G ps"' Expiration Date: 3/3/ �ol y <br /> Phone: (cell) ,s/2 7 g7- S�.-SS (office) `�5�� ZSS- 3 7�� <br /> Mailing Address: —�;d �d4/ r. .Srw' � yo6 Ci : ;,,,��� ZIP: � <br /> Contact Person: �� }f.i/u,��t Applicant is: ontrac o / Homeowner (Clyde One) <br /> Email and/or Fax: __�fc� �„� -/,�,�S Co�, <br /> PROPERTY OWNER INFOi2MATION: <br /> Name: .�r�e,��Lo ?acvbS <br /> Phone(day): <br /> Address: /�cG ��ore/,�,5� ar City: �yn��c� ZIP:SS39/ <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: R DS �' <br /> Phone(day): (�/2� 8'/0- 625� <br /> Address: ljg'Op /fuy 69 5��� 30'� C�tY: ./1�'�w �"f°.P�- Z�P� �yZ� <br /> Email and/or Fax: rS�orl•e�� CAµ�coc� - h e� <br /> PROJECT INFORMATION: Description of ro'ect: <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) �c�H,.�C,�� hC�� ❑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. (speClfy) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.o <br /> d� <br /> Estimated Construction Valuation (excluding land) '�.�e p0�• '— <br /> Packet Last Updated: 04119/2013 <br /> Page 22 of 23 <br />