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• T ��� �35��' <br /> City of Orono io <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: /d^ (P� <br /> Og,D �O Cr Box 66 <br /> CryD/ /O <br /> stal Bay, MN 55323-0066 Date received: / <br /> Received by: <br /> Street Address: <br /> sic, o~ 2750 Kelley ParkwayPlan review e: <br /> L9kESHj Orono, MN 55356 Al <br /> _— Total Fee: <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 be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: (b 50 766 4'4 w R L o Zaee SS 356, <br /> Will this 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 /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Scc— f Cin, Yenrius <br /> State License# Zo3 I ep.Z 3 Z Expiration Date: 0-5/-1 ( 20 <br /> Phone: E S(— 7 3Q - 1�2 g 1( (office) (cell) k5'1-700- <br /> Mailing <br /> ,5'i-700- <br /> Mailing Address: cam/ co,­, e,— 6f Cit : CA."v4 ZIP: 6-5' (7-5 z;z <br /> Contact Person: g2 l A r c u s Applicant is: ontracto / Homeowner (Circle One) <br /> Email and/or Fax: Tln ewc(wS Cc NEIP5 6571'70 Z- <br /> PROPERTY OWNER INFORMATI N: <br /> Name: /h1V-t lqvvdk <br /> Phone(day): y s2 - 217- 2 3 t+ <br /> Address: &So 7-0,1 k a wo 2 City: L­,l C u/ct ZIP: 5-5;-75G <br /> Email and/or Fax <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 /> ❑ New Construction Single Family with Residence <br /> ❑Addition attached garage Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building Dam a El Single Family with El Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ® Other: (specify) eleS*o rzt44bn ❑ 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 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) $ <br />