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LP I-s -13 <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 16-16- 13 <br /> Street Address:' Received by: 65 <br /> y 2750 Kelley Parkway A2 S <br /> F �c` Orono, MN 55356 Plan review fee: <br /> �gkEstio Main: 952-259-4600 Total Fee: _t� <br /> Fax: 952-249-4616 www.ci.orono.mn.us ac -j-b <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: / �0✓�l�Gl.�G /Z� <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 INFORVATION: <br /> Name: IzoloaT Go✓tsfrvr,��/+ <br /> State License# 4r C_ 630 63 Expiration Date: 3=3/- z0/S/ <br /> Phone: (cell)6/Z -9-7-,x5 (office) <br /> Mailing Address: C/ ZIP: ,5-SyZ1 <br /> Contact Person: ;rZ& G�s�acr _ Applicant is. Contracto / Homeowner (circle one) <br /> Email and/or Fax: aG•G0•-1 <br /> PROPERTY OWNER INfOR,MA 'ION: <br /> Name: or Gar/ lel if <br /> F <br /> Phone (day): gas- VZ8-L�83g <br /> Address: gig/ ?oro Cala./f led City:0ioA/0 ZIP: <br /> Email and/or Fax 14,o/4@fi4,e ,e cam, <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <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 gGarage/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 ❑ Public Water <br /> "Any earth movement may require ❑ Commercial ❑Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) '0 Other: (specify) <br /> 18202 Minnetonka Blvd imp` eGU�I�(af�Gdb, <br /> Deephaven,MN 55391 7 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.min nehah creek.or <br /> Estimated Construction Valuation (excluding land) $ 0 <br /> Packet Last Updated. 04/19/2013 <br />