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It <br /> . _ d, <br /> 05 . 6-0 <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: .2009)-41,-02,3 <br /> cv, <br /> O� <br /> Crystal Bay, MN 55323-0066 Date received: /� �W O 9 <br /> ` Received by: <br /> A 4 , Street Address:' <br /> int efl;i , .,o~ 2750 Kelley Parkway Plan review fee: 1 40 7 // <br /> 9kESHd4Orono, MN 55356 <br /> o2ro9— 000Pz� <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: ����hh//////��, <br /> Job Site Address: `7tJ�7iJ hi 4/-6-k1-674/4/ geQ4 Q, ©fid\0 <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. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: PV/LL, /C CMZ 7 /Z f- A .7: k-/ <br /> State License# --- Expiration Date: <br /> Phone: 2-01- 4vs ©Qc/(&Jf s��(office) cell) <br /> Mailing Address: BCK ecf City: /(O J/I(L10 (AkZIP: 55- <br /> Contact Person: W t(,L1 (,, Applicant is: Contractor / Homeowner (circle One) <br /> Email and/or Fax: W I(.0 a i.1 a cpp gVF)0h%1c I/'CD'YVI <br /> PROPERTY OWNER INFORMATION: <br /> Name: Eierc.. ce k <br /> Phone (day): (a i Z. • -1-q 0 • 23 -' ` <br /> Address: 'feyp fnfFl--c}2--Oki0J ILOAO City: OROWO ZIP: /VI.N <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: No/Uc <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 0 Residence <br /> 0 Addition attached garage 0 Garage/Accessory Bldg. 0 Public Sewer <br /> 0 Accessory Building tot Single Family with -at Deck <br /> Relocation s detached garage 0 Office/Commercial Private Sewer <br /> Other: (specify) 1- -(O(L- ` e_cle_❑ Multiple Family/Condo 0 Warehouse <br /> ❑ Public 0 Storage 0 Public Water <br /> **Any earth moveme may require ❑ Commercial 0 Other(specify) <br /> MCWD review& rmits. 0 Industrial Private Well <br /> Minnehaha Cre atershed District(MCWD) ❑ Other: (specify) <br /> 18202 Min onka Blvd <br /> Deep en,MN 55391 <br /> P ne: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ 3,5 o - <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />