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0"'2.1 <br /> • <br /> City of Orono <br /> Building Permit Application 3/a -75 <br /> for New Structures or Additions <br /> Mailing Address: Permit number: 37 Ll <br /> PO Box 66 p <br /> Crystal Bay, MN 55323-0066 Date received: — <br /> v, O <br /> II �* <br /> Street Address: Received by: <br /> � <br /> \ ti 2750� Kelley Parkway Y Y Plan review fee: l c��j 5. <br /> �t\kOrono, MN 55356 cka G —4 <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: 7 A, p <br /> Will this be a Parade of Homes, Remodelers Showcase Home oro her 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 INFO ATION:, <br /> Name: 'LO 16fin JK�S <br /> State License# 90S C>0'7 Expiration Date: Z ' <br /> Phone: -D'79-1 office) ce I <br /> Mailing Address: $L Gam- ( An City: ZIP: // <br /> Contact Person: DLIJ 4 Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: u o <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: ri+• <br /> Email and/or Fax <br /> ARCHITECT/ ENG,t EER INFORMATION: <br /> Name: ` <br /> Phone (day): <br /> Address: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: \� <br /> 1. Type of Project 2. Proposed Use <br /> New Construction ❑ Single Family with <br /> Addition attached garage /[ <br /> ❑ Accessory Building Single Family with [ <br /> ❑ Relocation Al_detached garage ❑ �1 <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ N" <br /> ❑ Public ❑ <br /> **Any earth movement may require ❑ Commercial ❑ <br /> MCWD review& permits. ❑ Industrial <br /> MCWD El Private Well <br /> Minnehaha Creek Watershed District <br /> ( ) ❑ Other. (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.ora <br /> Estimated Construction Valuation (excluding land) $ 41D(� <br />