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� � 5�a�« �,� <br /> � �5 <br /> � � . <br /> 1 ( � <br /> City of Orono <br /> � <br /> Building Permit Application �Ly �� �,�- <br /> for New Structures or Additions <br /> �O� MailiPO Bo�r66 Permit number: �Of -�/'7oZ <br /> �V Crystal Bay, MN 55323-0066 Date received: 3 /S/.3 <br /> O��':�� O � Received by: � <br /> a � �� �> �:� �, StreefAddress:' -7 <br /> �'.�,t � Gti 2750 Kelley Parkway Plan review fee: J 1� l - ��" <br /> �kESH�� Orono, MN 55356 oZo/3 - L9 D 17/ <br /> � -_ � Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us ESC,Y�11M � Q''Z� <br /> This application form must be completed in full and all required information must be submitted. ��_ppZ,�,p <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � � � � S ;��� ;�,� ✓� , <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/APR�6ANTINFORMATIO : <br /> Name: J �r ✓t �(/� S C�/� <br /> State License# Expiration Date: <br /> Phone: ( � � L ffice cell <br /> Mailing Address: ('j 5- �p� Cit : c� <br /> Contact Person: "7 � }cs�-.� A plicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: �a 2 ,,,� S v-�- I.�,o p , <br /> PROPERTY OWNER INFORMATION: / _ <br /> Name: S w,..._ p�L S �:.�✓� _ <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION:� 1L <br /> Name: �t �(Q S � C'�lC�-"�- � � a-�n ��� <br /> Phone (day): G � � <br /> Address: �� .� � Cit : Gr : S� � <br /> Email and/or Fax: 1tio,,.,e_ � lc�,,,�, �..: <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 /> �'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 ❑ 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) $ % Z d �� <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />