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� <br /> y • ��� <br /> ' . a-`� �S <br /> City of Orono � (0� <br /> Building Permit �4pplication <br /> � �D �,��� <br /> for New Structures or Additions <br /> Mailing Address: <br /> Q PO Box 66 Permit number: �� � —Z3�$'J <br /> � �Q Crystal Bay, MN 55323-0066 Date received: p=�-v_�_ <br /> StreetAddress:' Received by: ��� <br /> y� ,�'� 2750 Kelley Parkway Plan review fee: . � � <br /> C.` Orono, MN 55356 <br /> 1qK�sHo��` Main: 952-259-4600 Total Fee: a��� -� $ � <br /> Fax: 952-249-4616 www.ci orono.mn.us <br /> This�pplication 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: j ji�r� �l��r j�;�.P �,�. d r��,r_, ��,AJ ���q/ <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 City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su(ficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: �N � �n.r„N_5 L�-� <br /> State License# �� � � �3— Expiration Date: ;:i/3/ / �.ol�f <br /> Phone: _�cell) 6i 2� i g7— S LgS (office) `����� LSS- 's 7 r�� <br /> Mailing Address: ��9//�Gq� ��/P tlr. .Sa:�� yo�� Citv:/+1;.+,:r��� ZIP: —C:3_n� <br /> Contact Person: �,�.� "/�,j/,,,�� Ap�licant is: ontrac o ' / Homeowner (Circle One) <br /> Email and/or Fax: pe /,Hh -J,�,,,,eS � cc>�, <br /> PROPERTY OWNER INFORMATION: <br /> Name: �r�„ilq ?�<�`o b S <br /> Phone (day): <br /> Address: /7t�o 5.���/f,�c Q r City: C%yn,�rs ZIP:S S39/ <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: I(1�S f�rc/,i�-rc� <br /> Phone (day): �6/Z) �/o •- �bZ,�� <br /> Address: �C� /�uy 6�' Su1�c 30`; City: �J/�L,, 1-fo�� ZIP: SSy�� <br /> Email and/or Fax: }�-S��y-/•e�� Co.--.f�S� - h e� <br /> PROJECT INFORMATION: Description of project:________ <br /> ----------------------------------- <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. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial �Private Sewer <br /> ,�Other. (specify) �rN,.�GI�`fc�_�_w_��r�r.��/ ❑ Multiple Famity/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 /> Estimated Construction Valuation (excluding land) $ '7,�`�pp�. `�J <br /> � <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />