Laserfiche WebLink
. � � o5Z � �i <br /> � � <br /> Cit of Orono �'''� <br /> Y �4� <br /> Building Permit Application � <br /> for New Structures or Additions;�'/ <br /> �/�__—� Mailing Address: Permit number, c�0/D—�O 7p(� <br /> 4u 0,�\ PO Box 66 <br /> � Crystal Bay, MN 55323-0066 Date received: <br /> 0 ,:,. � '�, <br /> 3s <br /> ��a ��f��-:=: s,;l' StreetAddress' Received by: <br /> \�'�t����;:,�,. �� 2750 Kelley Parkway Plan review fee: �89 <br /> �9kE�H g�' Orono, MN 55356 <br /> _- �ro/o -DOlo�9`� <br /> Tofal 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: G'j �l�(, fl,f��j <br /> Will this be a Parade of Homes, Remod ers Showcase Home or other Display Home? ❑ Yes � No <br /> Hyes,a special event permit is required with Po/ice Department and Cify Counci/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 evenis will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: u�.1 P� l��Ci(Z.s ,� Go o�t.i4 <br /> State License# Q�p �O�SQ-� xpiratio Date: 3 20 12 <br /> Phone: °1.52. 4 7 G . �� a q (office) ln l2. 3 l�q 2g 3(.c (cell) <br /> Mailing Address: 1 MT A� . $LY Cit : G,� 1�E►Y��I ZIP: �'j � <br /> Contact Person: � Applicant is: on ractor / Homeowner (Circle One) <br /> Email and/or Fax: �„ . h � � r S GO <br /> PROPERTY OWNER INFORMATION: <br /> Name: �ci�}�c CL� � z a�1�, --' (�Gl-{Al2 D � Z�rI,A �Q�U S� <br /> Phone (day): G�w 1012, 3E11 , �3S l <br /> Address: �C� �z.g,pR.. Gp�t �Lrt- CitY'Toc•l�A ��1 Z1P: r533 I <br /> Email and/or Fax rc�Z.oy�A ,p Z,pha-�'�r�a�r�c.� . c..oLr. <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: µ � �'�h! <br /> Phone (day): q, 2. Q , <br /> Address: (,p p�} � � S ��Q Cit : (L ZIP: -�j�?� ( <br /> Email andbr Fax: � r,r� �- � ,r- t� ���,,,� <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) � Othef: (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) $ �� G> a� � (o(,p � �(� <br /> Last Updated: 9/29/2009 <br /> - 17- <br />