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City of Orono iCJ 1 . <br /> Building Permit Applicatio <br /> for New Structures or Addition <br /> Mailing Address: Peru number. .26)1,3-0 ZB Q <br /> PO Box 66 <br /> Crystal Bay,MN 55323-0066 Date rocew: <br /> Street Address:' Received by; <br /> a Z 2750 Kelley Parkway plan fevle'w fee: ) f7 5 <br /> s� Orono,MN 55356 .201 <br /> ��KESH01`1' Main: 952-259.4600 Total Fee:'" <br /> Fax: 952-249 4616 l or m <br /> This application form must be completed in lull ant!all requirod intotmaGtxl must be submitted. r <br /> 3S <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: �7 �G� K��Clt <br /> Job Site Address: �`jj <br /> Will this be a Parade of Homes,Remodelers Showcase Home or other L)tsplay Homed LJ Yes In g <br /> if yes,a special avant permit is required with Police Department and City Council approval W days prior to the event. Shuffle bus service will be V <br /> required unless applicant demonstrates sufficient on-site parking is ovaNeble. Non-permitted events wO not be eNowed. <br /> CONTRACTOR I APPLICANT INFORMATION: 1%P OD f7 V <br /> Name: Expiration Date: P { �i f <br /> State License# t 0 7 <br /> Phone: cell _ office <br /> �t) O;ty � j � ZIP: 553.7 L <br /> Mailing Address: A Ilcant Is. Homeowner (cwdo Deal <br /> Contact Person: ' ter r1 PP <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATIO / L L I C <br /> Name: —� A <br /> Phone(day): �"`1 f ; <br /> Address: r <br /> Email and/or Fax C <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): Cit : ZIP: <br /> Address: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Desai U 27garage <br /> se p 3.Structure Type 4.Sewage Disposal& <br /> 1.Type of Project tWater Supply <br /> New Construction ❑ ily with ❑Residence �(,qU1 ❑public Sewer <br /> arage Garage/AesseeetYAddition ily with ❑Deck <br /> Accessory Building ❑ Ol{oe/Commercial ❑Private Sewer <br /> ❑Relocation arage ❑❑Other.tion y) mily/Condo ❑Warehouse ❑public Water <br /> ❑ ❑storage <br /> 'Any earth movement may require <br /> Commercial ❑Other(specify) C]Private Well <br /> ❑Industrial <br /> MCWD review&permits. ❑ <br /> Minnehahe Creme Watershed District(MCWD) ❑Other:(specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-171-0590 <br /> Fax: 952471.0682 <br /> www.minnehahacreek.org $ <br /> Estimated Construction Valuation(excluding land) <br /> Packet Last Updated: 04/19/2013 Page 22 of 23 <br />