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. . � j <br /> City of Orono �.� <br /> . . � �9� � <br /> 'U��� Build�n Permit A I�cation � <br /> � J pp � <br /> for New Structures or Additions � <br /> Mailing Address: Pe�rrfit numb+�r. �v g��� <br /> �,O�. PO Box 66 <br /> O � O ; Crystal Bay, MN 55323-0066 �ate receive�: � <br /> �, Street Address:' R����' ��� <br /> 2750 Kelley Parkway Plan review fee: ���� <br /> l.q�.��og�� Orono,MN 55356 . : ad�-�p��� <br /> �'otal�ee; <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 b . <br /> Incomplete applications will be retumed. (P►ease prinf) <br /> GENERAL INFORMATION: <br /> Job Site Address: U � rZ <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑Yes o <br /> If yes, a special event permit is required with Police Depa►bnent and City Counal approval 60 days prior to the event Shuttle bus servi wi11 be <br /> required urtless applicant demortstrates sufFiaent on�ite parlting is availab/e. Non-permitfed e►rents wr71 not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �o��r� L�� � <br /> State License# �r v„�' Expiration Date: 3/3r f?O�v_ <br /> Phone: �5 -� office Z� S/U —2 S�vi cell <br /> Mailing Address: �5U�' Ch/ C' - E�4 ZIP: 5`S 3� � <br /> Conta�t Person: ��2iZ L o �LE Applicant is: Contractor / Homeowner (CircleOne) <br /> Email and/or Fax: 2f 2 �' � I .��►'i-- <br /> PROPERTY OWNER INFORMATIO • <br /> Name: �L'�/ � �c�vQ�n� ���5 <br /> Phone (day): �' <br /> Address: 2/O 7/3�l,c/U�� City: �,�U�d ZIP: Sj��� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFO��ON: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 7.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction ❑Single Family with ❑Residence <br /> ❑Addition attached garage ❑Garage/Accessory Bldg. ❑Pub19c Sewer <br /> ❑Accessory Buil�ng ❑ Single Family with fa'beck <br /> ❑ Relocation detached garage ❑Oifice/Commeraal ❑ 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 C�eek Watershed Distric�(MCWD) Other.{specify) <br /> 18202 Minnetonka BNd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> Estimated Construction Valuation (excluding land) S �O .Gn <br /> last Updated: 6/7212009 <br /> - 19- <br />