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1 <br /> � ' � �I°Tl( OF �I�ONO <br /> BUILDING PERMIT s4,PPLICATION �`� ���►,y� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> Mailing Address: ` _ ` <br /> Perm�tnumber ��� ` ��.:,;..'.�;: <br /> �-�� _ PO Box 66 ; <br /> '� Crystal Bay, MN 55323-0066 Dafe received (Q �y:-/ 7 <br /> - StreefAddress:' Received:by: � � 'y /1/��. <br /> ��� i�' 2750 Kelley Parkway Plan reView:fee: /. . �,f- : <br /> � Orono, MN 55356 <br /> �q�ESH.att4'` � — D D 7,>. . <br /> :Total Fee: <br /> Main: 952-249-4600 = Fax: 952-249-4616 www.ci.orono.mn.us <br /> .:::..::::...... <br /> l"hisapplication:form must.be�completed;in;fuJl;aritl all�requi"r,etl,info�matiorr:inusf:b�e.;subrriitted: <br /> Incomplete applications.:wili`be returned: (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 72 3 S'm a�gAY �G�d'�- ��-t V L= <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Dispiay Home? ❑Yes ❑ No <br /> lf yes,a special event permit is requi�d with Police Deparfinenf and City Council approva!60 days prior to the event Shuttle bus service will be <br /> reguired unless applicant demonstrates sufficient on-site parking is available. Non-permitted events wi!!not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �l,Joot�D�R�.€ gv��D�P-S <br /> StateLicense# BG00Z92(o ExpirationDate: 3-3I' IB <br /> Phone: (cell) (office) y5Z-3�5-0543 <br /> Mailing Address: 17 L�E G�RG�,E D IvE � �a� Cit : ZIP: 3 <br /> Contact Person: 1-r Applicant is: o tractor Homeowner (Circle One) <br /> EmailandlorFax: �u�r�s�r� i.vo a �bui de.�s .Co� <br /> � <br /> PROPERTY OWNER INFORMATION: <br /> Name: �c�r�->>= <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: � <br /> Name: ,SAM� <br /> Phone(day): I <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro"ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> �lew Construction ❑Single Family with �Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Buiiding ❑ Single Family with ❑Deck <br /> ❑Relocation detached garage ❑ Office/Commercial ❑Private Sewer <br /> ❑Other:(specify) �Multipie Family 1 Condo ❑Warehouse <br /> ❑ Public ❑Storage �'Public Water <br /> �..�ny�arin rnoverne�4 may aiso�ey-�;irc ❑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) $ � � �� �o� <br />