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7I47 l( S u.�Vvti'fti <br /> City of Orono S�`'y'`$ - <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: �nl�_ X59 <br /> / +D, PO Box 66 Permit number: <br /> Crystal Bay, MN 55323-0066 Date received: / / <br /> c <br /> i lReceived by: <br /> Street Address: <br /> �c, Gti 2Orono, MN 55356 750 Kelley Parkway- � �TO Plan review fee: L <br /> \LRifEsiio4�/ !O <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: •j. T- -CA-" ��o /o <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ YesNo <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 0 Fill <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: d iv ,�Ctx z5 P� 12,< <br /> State License# �p� Expiration Date: 9a/j <br /> Phone: 3 90oa (office) ­263 <br /> - oo ---fw3 (cell) <br /> Mailing Address: p v 2W,Z City: ./// ZIP: , <br /> Contact Person: Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: Cl <br /> PROPERTY OWNER INFORMATION: <br /> Name: t�l11 !y✓s ��TLrl1 CGX � <br /> Phone (day): <br /> Address: 3,SO-19- CtiAr" �_I %?0,40 City: aee"10 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 /> K'A <br /> Single Family with ❑ Residence New Construction Water Supply <br /> ❑ddition 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) T,v e5;8c4,..o /a ❑ 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.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ <br />