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Ci f r1,3CV . <br /> City o Orono � �. <br /> Building Permit Application <br /> _ for New Structures or Additions <br /> Mailing Address: Permit number: <br /> Og,O,�O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: - <br /> 14 s. Street Address:' <br /> Received by: <br /> 2750 Kelley Parkway Plan review fee: <br /> LEsso4� Orono, MN 55356 <br /> Total Fee: <br /> o2a�� c�5o <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us $ WOW Qd IL-I-q UA <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: -r _ <br /> Job Site Address: 36 GI 5- To O �c� O 20 vi S3 <br /> Will this be a Parade of Homes, Remodelers 8howcase 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 /> required unless applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed. <br /> CONTRACTOR/AglP ICANT INFORMATION: <br /> Name: G h l4 2h C— <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: 'PI-e1,12 <br /> Phone(day): 6,Y1 270 3 I n <br /> Address: 3 p0 0+0 tl vs City: 7 M +J1 ZIP: 57S-L( 11 Z <br /> Email and/or Fax tZ 2-K k.4,k 0y I , p M <br /> ®v; <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> �/ Water Supply <br /> p4 New Construction Single Family with Residence �/ <br /> ❑Addition attached garage Elu 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 N(Public Water <br /> 'Any earth movement may require ❑ 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) $ coo , po <br /> Last Updated: 1/26/2011 <br /> - 19- <br />