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T t��I( Su�v►�i�f- t <br /> City <br /> of Orono LTda� s -`' 0� cc, <br /> Building Permit Application bv\ <br /> for New Structures or Additions <br /> Mailing Address: <br /> 0, PO Box 66 <br /> Permitmumber <br /> Crystal Bay, MN 55323-0066 Datearecelved '7 / <br /> f A, Street Address:' 3ecervedby "� <br /> 2750 Kelley Parkway �(�� Ianeeview#ee: -Ob <br /> \ggH�g$ Orono, MN 55356 <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: Q _,. d 5�Ozj <br /> Will this be a Parade of Homes, Remod6lers 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 ill 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: �•`c� �ctx �A� I-14- ' <br /> State License# Expiration Date: ,goI3 <br /> Phone: 9oUa office .3 —30D -47eV3 cell <br /> Mailing Address: p v City: l ZIP: 6-5 Wz <br /> Contact Person: Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: 3S4!a2 EtiigT�,e 7 .v Pawo City: O,evAlo ZIP: <br /> Email and/or Fax <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 /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> Relocation �- detached garage ❑Office/Commercial ❑Private Sewer <br /> Other.(specify) 1�- m ❑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.m innehahecreek.o <br /> Estimated Construction Valuation(excluding land) $ <br />