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City of Orono a��'���°�� <br /> Building Permit Application oc� 2 9 2��4 <br /> for New Structures or Additions c�n c�= �t �:. �._ <br /> Mailing Address: <br /> O�r PO Box 66 Permit number: O�� —�/02. 9 <br /> `w0 Crystal Bay, MN 55323-0066 Date received: O <br /> StreetAddress:' Received by: <br /> y ,� 2750 Kelley Parkway Plan review fee: <br /> �' c,` Orono, MN 55356 <br /> �'� ESHO�� Main: 952-259-4600 Total Fee: �9(j>� � <br /> Fax: 952-249-4616 vrs;��v �i or�r� m�� �_is Y" <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 /> GE ERAL INFORMATION: <br /> Job Site Address: .s��� ��S-��X I�� <br /> Will his 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 /> requi d unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CO TRACTOR/APPLICANT INFORMATION: <br /> Nam : �"l.t= lfo�-..�r c, �C <br /> Stat License# (��- - ��5 a� y3 7 Expiration Date: 3 - �� ����.��- <br /> Pho e: cell /�Z - go .- �vr� office <br /> Maili g Address: � siy.s- 1'1 �s��,�� �l i .. City:Muy/-z �a.� ZIP: �s3 �� <br /> Cont ct Person: �c�� I= l�e Applicant is: eAtra� / Homeowner (Circle One) <br /> Ema I and/or Fax: '• v� � ; L� o��f,�c„-. <br /> �� <br /> PRO ERTY OWNE INF RMATION: <br /> Nam : l�; � �c ti�y c �r �.,�Z <br /> Pho e (day): <br /> Addr ss: 3l�O S';,1Jz�c f City: O!'6.�cr Nt�vZIP: <br /> Ema I and/or Fax <br /> ARC ITECT/ENGINEE INFORMATION: <br /> Nam : <br /> Pho e (day): <br /> Addr ss: — � City: ZIP: _ _ <br /> Ema I and/or Fax: <br /> PR JECT INFORMATION: Description of project: <br /> 1.Ty e of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> ❑ N w Construction ❑ Single Family with ❑ Residence <br /> ❑A dition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑A cessory Building ��;s���y ❑ Single Family with � Deck <br /> ❑ R location � detached garage ❑ Office/Commercial ❑ Private Sewer <br /> �Ot er: (specify) �XS�'�� (���a'�� ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> ''*An earth movement may require ❑ Commercial ❑ Other(specify) <br /> MC review&permits. ❑ Industrial ❑ Private Well <br /> Minne aha Creek Watershed District(MCWD) ❑ Other: (Specify) <br /> 18202 Minnetonka Blvd <br /> Deep aven, MN 55391 <br /> Phon : 952-471-0590 <br /> Fax: 52-471-0682 <br /> www. innehahacreek.or <br /> Esti ated Construction Valuation (excluding land) $ <br /> Packet Last Updated. 04/19/2013 <br /> Page 22 of 23 <br />