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Sep-03-2009 02:55pm From-CITY OF ORONO +9522494616 T-770 P.001/002 F-911 <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address; PerMhviniber: Z CSU - vZ <br /> p Cr Box Be <br /> Crystal Bay,MN 55323-0068 Date•reeeivad: <br /> ,a Street Address:' tecehredby: ? <br /> a` 2750 Kelley Parkway Rlap:r'Newfee;. <br /> Orono,MN 55356 <br /> Total�Fss. • . •�� �:t., <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 prino <br /> .GENERAL INFORMATION: <br /> Job.Site Address: 'AQO �jjmr_ IEi-o 1& 2 , \tAYzATA M553ctI <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 suffFclent onsite parking is available. Non permitted events 00 net be allowed, <br /> CONTRACTOR 1 APPLICANT INFORMATION: <br /> Name: H T Eft W00Q D SICK4&0 L L C- <br /> State License ANUMNOW Q0 6.3,CExpiration Gate: 31, to <br /> Phone: - office cell <br /> Mailing Address: P6 nmt Asr Ci :MA )„AIN ZIP: 653 <br /> Contact Person: AC=M Applicant is: ontrac o / Homeowner (cimie Ons) <br /> Email and/or Fax: bill&>bg:kYgr,%6CM& _f O on <br /> PROPERTY OWNER INFORMATION: <br /> Name: M Ay-►c Ct wi-A&S <br /> Phone(day): I b l z_- 3 - $q":A <br /> Address; —aim V City: WAYZA'm ZIP: !jsl <br /> Email and/or Fax markcjhU-.Lo.rQ Cpl.WM <br /> ARCHITECT I 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 Cl Single Family with ❑ Residence <br /> ❑Addition Attached garage Garage/Accessory Bldg. Q Public Sewer <br /> Q Accessory Building ❑ Single Family with i Deck <br /> 0 Relocation detached garage ❑Office/Commercial ❑ Private Sewer <br /> R Other.(specify) ()at k El Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage Q Public Water <br /> "Any earth movement may require 0 Commercial ❑Other(speclfy) <br /> MGWLTi"revlew;�permlts:---------•- ridUstrial-- —_...---- -Ptivate•Well—....—._ -...,....,, <br /> Minnehaha Creek Watershed District(MCWD) (] Other:(specify) <br /> 18202-Mipnetonka 131+d <br /> Deephaven,MN 55391 <br /> Phone, 952-471.0590 <br /> Fax: 952-471-0682 <br /> www.Minnehahacreek,prg <br /> Estimated Construction Valuation (excluding land) $ 10,000 <br /> Last Updated: $/=009 <br /> -19 <br />