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L°SCr'Uw <br /> City of Orono Z5�7 <br /> Building Permit Application <br /> for New Structures or Additions �Bz�, 5 dcce <br /> Mailing Address: Permit number. Q — 00 <br /> O.¢0PO Box 66 <br /> Crystal Bay,MN 553234)066 Date received: 111,4405 D <br /> a. Street Address.' Received by: Mle <br /> GtiE' 2750 Kelley Parkway Plan review fee: / l.J. 80 <br /> o81r Orono,MN 55356 c2-09 -O O '7,?7 <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.d.orono.mmus <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: 71-® /on kq wa ?J • 0(erg c A 941V <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? El Yes No <br /> 9 yes,a special event pearl/is required with Plohoe Department and City Council approval 60 days prior to the event Shuttle bus service*711 be <br /> required unless applicant demonstrates sufficient on-site paddng is available_ Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ��r"�r Pro p; <br /> State License# (Q& XI Expiration Date: <br /> Phone: If 5- office &1)- S� cell <br /> Mailing Address: mCKte'r City: fir .1 ZIP: <br /> Contact Person: Applicant is: m t Homeowner Ic:do one) <br /> Email and/or Fax: rit'rorngpriees P !eanr&S7�. hP <br /> PROPERTY OWNER INFORMATION: <br /> Name: -1- a161 ikerihv medjlell-ell <br /> Phone(day): 1 - S" <br /> Address: city: e(on 0 ZIP: <br /> Email and/or Fax , - r' ✓fir �` <br /> ARCHITECT/ENGINEER INFORMATION: // <br /> Name: FoX-1 pfd 1%��� Ud��ln LafS9n <br /> Phone(day): / <br /> Address: t , ^Pm ert'd /tw y City: r4 f Ce" ZIP: <br /> Email and/or Fax: `V c <br /> etV4)1,1/ a Go x- <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 Single Family with ❑Deck <br /> ❑Relocation detached garage ❑Office/Commerdal ❑Private Sewer <br /> ❑Other.(specify) ❑Multiple Family/Condo ❑Warehouse <br /> ❑Public ❑Storage ❑Public Water <br /> "Any earth movement may require ❑Commercial ❑Other(specify) <br /> MCWD review A permits. ❑Industrial Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other.(specify) <br /> 113202 MWa etonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minneha <br /> Estimated Construction Valuation(excluding land) ; iv /o, CCPD <br /> Last Updated: 6122@009 <br /> -19- <br />