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s � <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: � <br /> �,L,�� PO Box 66 Permit number: � Q/(J—C ��� <br /> 0 ,A � Crystal Bay, MN 55323-0066 Date received: <br /> � �A,��� <br /> ��-��' �, Street Address:� Received by: <br /> ��L c ��:� <br /> � �� " 2750 Kelley Parkway Plan review fee: <br /> '�kEsxo�''� Orono, MN 55356 <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: -' � � ,,,, �� � �, � ,� <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 Crty Council approval 60 days prior to the event. Shuttle bus servic will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR 1 APPLICANT INFORMATION: n <br /> Name: ��./���t-fel s ta���� ������ 1-�elX f �v�c-, <br /> State License# ���,��? q[/ Expiration Date: _ <br /> Phone: �, - � - ys office � i - � -- cell <br /> Mailing Address: Pp, o S- Cit : t� �,� ZIP:�-S- <br /> Contact Person: --T�,.� .�il ,�..�-F� �-j-u c�.-�- Applicant is: Contractor / Homeowner (Circle One) �- <br /> Email and/or Fax: y� Z _q�S=�,� �3 <br /> PROPERTY OWNER INFORMATION: <br /> Name: �`��� �,���,-_ � <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax: ` <br /> PROJECT INFORMATION: �c�w�C ��p/' C�l� <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 « �r ����,��C detached garage ❑ Office/Commercial <br /> ❑ Other: s eci ❑ Private Sewer <br /> ( p fY) �� Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> '*Any earth movement may require �-.Commercial ❑ Other(specify) <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) $ <br /> Last Updated: 9/29/2009 <br /> 17 - <br /> �• l� '� G�S� G'''/l/�-w�,,.� A-r�-f'� �f-��v�-L <br /> � <br />