Laserfiche WebLink
4L.So t%T'rAC RE D Z sET5 <br /> LE `;EP _rC- d- <br /> ' l SET OF P601- 'X U-Fo . <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Q O MailiPO Box 66 Permit number: <br /> Qy_ 0 Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' Received by: <br /> 2750 Kelley Parkwayp, gol d- <br /> Bo <br /> 9 g Orono, MN 55356 �d C IL j U 1 Ian review fee: <br /> L kEs � <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: g6 q,5 6U,4`rERTOctJ_v g0A b <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. E <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: 66Rlk0/0 S cc'y5;XUCTJ=0-t,-, <br /> State License# ' G S3)crG I Expiration Date: 3 - j a0I 3 <br /> Phone: q?4-311 `? (office) U/,� 3(o - 3 73 C (cell) <br /> Mailing Address: PO sox so !o City: M4N't:F- LhFLn.)ZIP: SS <br /> Contact Person: �p-,E yv/c hApplicant is: ontrac or Homeowner (circle one) <br /> Email and/or Fax: 'c e ©,,d ctm es, .-, <br /> PROPERTY OWNER INFORMATION: <br /> Name: PETER + .DA (Ji4,i) 01/ER t3EKC <br /> Phone (day): t - a <br /> Address: City: ZIP: <br /> Email and/or Fax a ma vi a v. . ✓►I ✓a vi o u e 6e k e (-'- a C Ce-+i J-LA-e <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: p F. -P. N_P,,J1V-rN6 d- J!�E S.,T6-✓ <br /> Phone(day): (7&3-) 7 FO- yo(n4 <br /> Address: QI pD 9A-L7'rr*aRE !T-, arse - -' joe, City: /3CAt.V E ZIP: S5-LM � <br /> Email and/or Fax: 'n-Po P cl p des <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> OWater Supply <br /> New Construction Single Family with Residence <br /> ❑Addition attached garage 9(Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑Office/Commercial XPrivate 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.minnehahacM2K0_r <br /> Estimated Construction Valuation (excluding land) 9 1 V ( 00o , <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />