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City of Orono <br /> Building Permit Application #3 33 . 70 <br /> for New Structures or Additions <br /> Mailing Address: <br /> �Q A, PO Box 66 , ` Permit number: ��/ V—dZ, �7 <br /> 0 <br /> Crystal Ba MN 55323-0066 1�— <br /> rY Y. Date received: J.� —/� <br /> Street Address:' Received by: 44, <br /> y_ * 2750 Kelley Parkwa \� \ Plan review fee: (57D. 9�3 <br /> c` Orono, MN 55356 <br /> �ikFstto�`� Main: 952-259-4600 Total Fee: <br /> ©��-DDa77 <br /> Fax: 952-249-4616 I www.ci.orono.mn us I <br /> This application form must be completed in full and all required information must be submittecjri,�# Z7�0 <br /> Incomplete applications will be returned. (Please print) (�,� <br /> GENERAL INFORMATION: <br /> Job Site Address: 4105- ki4 z rl ? , E, :n, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [1 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: .Th ?Rc;.,aa4.._ <br /> State License# Explratic;: - <br /> Phone: (cell) (c,' .. 232.. kcize, (office) <br /> Mailing Address: City: <br /> Contact Person: Applicant is: Contractor / wrier (circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATivm <br /> Name: 'b ?;uNAn,L.- <br /> Phone (day): (,Q‘2 Z'3 c> l 2,1 <br /> Address: LCiDSA 'cN J City: U Az, ZIP: acs <br /> Email and/or Fax I_E .t. aEIZE\& (w , cc IAA <br /> ARCHITECT/ENGINEER INFORMATivri: <br /> Name: `�p�rr+cANID A.J,c_471,4Cp5 <br /> Phone (day): 7rS) 87y ,3 <br /> - 01 -- ../4/1Address: ��y 5--E7*Sr City: £ACJ CCAs ZIP: 5,(7o3 <br /> Email and/or Fax: -7ic, Ely- y113 4), <br /> PROJECT INFORMATION: Description of project: C UkE 1) ;\.L ,.•K:r - r" ce <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction 0 Single Family with Residence <br /> Addition attached garage Garage/Accessory Bldg. 0 Public Sewer <br /> Accessory Building 0 Single Family with Deck <br /> Relocation detached garage <br /> 0 Office/Commercial ❑ Private Sewer <br /> 0 Other: (specify) ❑ Multiple Family/Condo 0 Warehouse <br /> 0 Public ❑ Storage ❑ Public Water <br /> **Any earth movement may require 0 Commercial ❑ Other(specify) <br /> MCWD review& permits. 0 Industrial 0 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 /> Iwww.minnehahacreek.orq I <br /> Estimated Construction Valuation (excluding land) $ ! g)q00 . - <br /> Packet Last Updated: 04/19/2013 <br />