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. . � <br /> City of Orono ��� <br /> Building Permit Application � <br /> for New Structures or Additions <br /> Mailing Address: `� �' <br /> �Q,�TO PO Box 66 Permit number: <br /> `V Crystal Bay, MN 55323-0066 � Date received: ��� <br /> Street Address:' Received by: �Yf <br /> -� 2750 Kelle Parkwa � ��� �� � <br /> y �" y y Plan review fee: <br /> F �` Orono, MN 55356 /�Iti <br /> !�'FFSHOR� Main: 952-259-4600 Total Fee: ����'� �� <br /> 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: 2.1 v�' Ct� �l:� (p <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 sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ,� �-� v �Xn(�S.saa' CArLs-�-r-�a,n 7'J1G,. <br /> State License# �� � � Expiration Date: 3�3��%b <br /> Phone: (cell) ���-N��_],y Ir (office) e��a�b�ys3 <br /> Mailing Address: Cit � �14 ZIP: �1 <br /> Contact Person: � a Applicant is: Contracto / Homeowner (Circle One) <br /> Email and/or Fax: t�.c�e.e�� ', <br /> PROPERTY OWNER INFORMATION: <br /> Name: �r� n h �iVOGY��G�b� S , 'L►�►G. • � <br /> Phone (day): 52 � '13- 'Z 0� �e3 - 3So— <br /> Address: :Z..I D Go Sfl Citv: , �.. �_.�c2� ZIP: -?�_(o <br /> Email and/or Fax mC�G e�. vl� p tt�v� � WC� ICe�� S �Ca^^ �e '. � Z � 7� � �' 2. <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Add ress: City: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <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 /> �ddition attached garage Garage/Accessory Bldg. ❑ Public Sewer <br /> Accessory Building ❑ Single Family with Deck <br /> ❑ elocation 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 /> Estimated Construction Valuation (excluding land) $ � ��ML� <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />