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ti <br /> City of Orono 5D <br /> g54' <br /> 9 pp <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> PO Box 66 Permit number: <br /> 0 Crystal Bay, MN 55323-006V <br /> Date received: <br /> Street Address.* <br /> Parkway s:' r'I Received by: <br /> 2750 Kelleyf V VI �� <br /> Plan review fee: <br /> Orono, MN 55356 J�o� <br /> I <br /> ESHO�� Main: 952-259-4600 Total Fee: a�y <br /> Fax: 952-249-4616 www.ci.orono.mn.us - +_ <br /> This application form must be completed in full and all required information mi.14 be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 32.0 -fvp_i,i o F-p ; `t✓wPk6-- MrJ Sj 3S_9 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes Pa No <br /> ff 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: r-lvw sc_k�k <br /> State License# B.C. 178795 Expiration Date: 3 3 zoi(o <br /> Phone: (cell) (en,ZOG- IQo3 (office) 1051.2ocv I'8o3 <br /> Mailing Address: 2gIS" E <3—, City: Iu,NNE-P-� S ZIP: Allft <br /> Contact Person: �_\&k sckwl kOT Applicant is: ontrac_ / Homeowner (circle one) <br /> Email and/or Fax: Otz-urs -cx-� ,au.-coo-1 <br /> PROPERTY OWNER INFORMATION: 's <br /> Name: Ttf F s pE I% bF_1N=_PI-5 <br /> Phone (day): 6912- , 742 <br /> Address: 320 City: r-�pl& Qlai,J ZIP: 5 359 <br /> Email and/or Fax -1b,r_� - j <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 5�-Garage/Accessory Bldg. ❑ Public Sewer <br /> RAccessory 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) ❑ 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) $ tfa S� �'O , O <br /> Packet Last Updated: 04/1911013 <br /> Page 22 of 23 <br />