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_. �} � �� ���z��� � <br /> �i� <br /> � Cit of Orono C� <br /> Y <br /> Building Permit Application <br /> for New Structures or Additions � �a�O' �� <br /> Mailing Address: Permit number. a�flj/—Od!�.� <br /> � PO Box 66 <br /> � 0 Crystal Bay, MN 55323-0066 Date received: -^I� �� <br /> � F StreetAddress:' Received by. �� <br /> ,�, �ti 2750 Kelley Parkway Plan review fee: 7 .�� '�:E^7 <br /> w Orono, MN 55356 �0������� G� <br /> Total Fee: <br /> ain: 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. (P/ease print) <br /> GEN f�A NFORMATION: i <br /> Job itae dress: ���O � 55� R d <br /> Will t i� b Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes, speci event permit is required with Police Department and City Counci/approva160 days prior to the event Shuttle bus service will be <br /> require unles pplicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed. <br /> CON RjAC R/APPUCANT INFORMATION: <br /> Name L , G,r-��.�,^ (,7��:�,w�2.� � gw, �c�a�-S <br /> State i�en # ' O Expiration Date: <br /> Phon : a— � office � — 3 p cell /�qr k� <br /> Mailin Ad ss: 00 'v�G� L �� Cit : �' r� ^ ZIP: <br /> Cont t Pe on: L�:,.rr v Gra w.4� Applicant is: o ra / Homeowner (Circle One) <br /> Email amd! Fax: <br /> PRO ER OWNER INFORMATION: <br /> Nam : �l' 't' .��,c�eS'SUv� <br /> Phon (da '73— �� <br /> Addr s8: ?� l �O �t,�_�-�,jC (Zc� City: Q�'O N O ZIP: <br /> Email a�d/ Fax <br /> i <br /> ARC ItE /ENGINEER INFORMATION: <br /> Nam : <br /> Phon Qda : <br /> Addr s�: City: ZIP: <br /> Emai and/ Fax: <br /> PR �C INFORMATION: Lo w�e,r- LP,u�e�, �"i � ,s h — D�.C�- —E'o �G�"�te,n, T BY'Gt�� <br /> 1.T e of oject 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ N Co truction � Single Family with Residence <br /> �A ition attached garage �Garage/Accessory Bldg: ❑ Public Sewer <br /> ❑A e�sso Building ❑ Single Family with ❑ Deck <br /> ❑ R locati detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ �r:( cify) ❑ Multiple Family/Condo ❑Warehouse <br /> ' ❑ Public ❑Storage �Public Water <br /> "'kAn e rt ovement may require ❑ Commercial ❑Other(specify) <br /> MC ev' 8�permits. ❑ Industrial ❑ Private Well <br /> Minne a a ek Watershed District(MCWD) ❑ pther:(specify) <br /> 1820 M nne nka Blvd <br /> Deep a en, N 55391 <br /> Phon : 52 1-0590 <br /> Fax: 5 -47 0682 <br /> www. i neh acreek.o <br /> Esti a�ed onstruction Valuation(excluding land) $ � � �, �i� <br /> LBst dated: 1/26/2011 --r <br /> - 19- <br />