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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> PO Box 66 Permit number ��/3 <br /> Q Crystal Bay,MN 55323-0066 Date received; 2' �g'• <br /> Street Address:' Received by: <br /> 2750 Kelley Parkway <br /> Orono.MN 55356 Plan review fee: <br /> Main: 98Z 249-4600 Fax: 952-249-4616 Total Fee: <br /> Nw.a.orono.mndus <br /> TMtappgtation form must be tAmploted in full and all requirt3d,�must be submitted. <br /> GENERAL INFORMATION: <br /> Incomplete applications will be returned. (Please print)Job Site Address: 3,2145 Mate/hwr1 I2 <br /> oa-d <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> Hyes,a specie!event penin is required w&h Police Department and City Council approval 60 days prur 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 I APPLICANT INFORMATION: <br /> Name. rr ,e r ner7 ecn z a i 1-,, c !� ne _ <br /> State License# Expiration Date: <br /> Phone: office ?If ;k- cell <br /> Mailing Address: /e N.!I dSte Ao city: ('orcorr.-, ZIP: S3 <br /> Contact Person: `* <br /> �°� LJr' Applicant is. ,I Homeowner (circleone) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: OOO ff"- <br /> Name: - & ( P <br /> l Ct ar»t± <br /> Phone(day): q o. c I <br /> Address: 7.2 4 4Z cit)E. Lo#ij Lake zip: 55,35,G <br /> Email and/or Fax Aj tY12 4t� Dir, <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: L A <br /> Phone(day): _ <br /> Address: Cit ; ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> 8 New ConstructionWater Supply <br /> ❑Single f=amily with ❑Residence <br /> ❑Addition attached garage B Garage I Acca <br /> ❑Accessory Building El Single Family with ❑Deck Accessory Bldg' Public Sewer <br /> ❑Relocation detached garage ❑Office/Commercial ❑Private Sewer <br /> ❑Other.(specify) ❑Multiple Family/Condo ❑Warehouse i <br /> ❑Public ❑Storage ❑Public Water i <br /> "Any earth movement may require ❑Commercial ❑Other(specify) <br /> Ill review 3 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 /> .uv vv.mr <br /> Estimated Construction Valuation(excluding land) 10 0 0 . eu <br />