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City of Orono 4W <br /> Building Permit Application / <br /> for New Structures or Additions <br /> --- Mailing Address: Permit number: o&Z2—00 7/ <br /> g,0PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' Received by: <br /> G <br /> 2750 Kelley Parkway Plan review fee: <br /> Orono,MN 55356 ax p <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: 99.E GiA- 0Wy1 �D, O (W10 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes EkNo <br /> rf 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.' !; ,. <br /> State License# L3 G Expiration Date: -31-13 <br /> Phone: lvla:.3/O-5N9 tell (office) (cell) <br /> Mailing Address: A7 L-r) A . City: ! ZIP: <br /> Contact Person: 4±! ,04- Applicant is: tractor / Homeowner (circle one) <br /> Email and/or Fax: C®Pol <br /> PROPERTY OWNER INFORMATION: <br /> Name: Gly i(i` S 5114-11A <br /> Phone(day): ¢5,2413-75'97 <br /> Address: E7t9915 wkTey-rov,,A K0 city: fp ZIP: SS3��o <br /> Email and/or Fax c-KrV co A l brfO , COM <br /> ARCHITECT/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 ❑Single Family with ❑ Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> [gAccessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑Office/CommercialPrivate Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage ❑ Public Water <br /> **Any earth movement may require ❑ Commercial 00t er(specify) .> <br /> MCWD review&permits. ❑ Industrial ( Private Well <br /> Minnehaha Creek Watershed District(MCWD) [ ( hqr s ecify��� <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.o <br /> Estimated Construction Valuation (excluding land) $ J q©y <br />