Laserfiche WebLink
a, <br /> F , <br /> i <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions �A ,c9C 7 <br /> Mailing Address: Permit number. 2-- <br /> y � � _ �� <br /> PO Box 66 Date received: <br /> �° Crystal Bay, MN 55323-0066 ( I I (' <br /> (�\\ Received by: �. <br /> Street Address:' # 7 2-°'---3g/ <br /> g <br /> a F 2750 Kelley Parkway ,..,'",;(‘Lc(-0C4/0(,.---- <br /> .>('Lc -0C4/0k Plan review fee: .�00'-�!d'', <br /> ��t '�.�;� ' Orono, MN 55356 Total Fee: <br /> �k'ESH�� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed <br /> oin full <br /> ill be all <br /> r quir d information <br /> ase �must be submitted. <br /> Incomplete app ,� `;��L�zc�tC � \U� <br /> Vii? u-) C' Va. f:54,-)-5c7- <br /> , <br /> c c <br /> GENERAL INFORMATION: '`� � r z-c�-C - r � �-�1 f' "�n� J J � <br /> Job Site Address: ?� • I � "� <br /> Will this be a Parade of Homes, Remodeler- •howcase Home or other Disp ay Home? Yes <br /> No <br /> tf yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: C. �.� `� <br /> . ( c CC't vc. �z <br /> Name: Z'ZExpiration Date: _c cell <br /> State License# office '/2 �'� <br /> Phone: 6 -q (f office . ZIP: �� -,i5C <br /> P�Iv „ , Cit : ' <br /> ConMailingtact <br /> Address: 0 W . WG '' Ar_, P>1 is: Contracto / Homeowner (circle one) <br /> Contact Person: 00 "D �^ -i-- "� - v 4., � ,, ".,-c"- <br /> Email and/or Fax: C'i-JYt,,.t Lid.. - , A <br /> PROPERTY OWNER INFORMATION: C' 1� kName: 1L �,�� VI- <br /> Miff ‘' --7-7 _, / /� ZIP: JJ<� <br /> Address: <br /> (day): , 1,41, WGc. , .� 1-u-- -( . Cit : -c(4- <br /> Address: Z OZ• �-G C �� <br /> Email and/or Fax - <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): Cit : ZIP: <br /> Address: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: 3. Structure Type 4.Sewage Disposal&1.Type of Project <br /> 2. Proposed Use Water Supply <br /> ❑ New Construction <br /> 0 Single Family with 0 Residence <br /> Garage/Accessory Bldg. 0 Public Sewer <br /> Access attached garage ❑ g❑ Single Family with ❑ Deck Private Sewer <br /> Accessory Building detached garage [.Office/Commercial <br /> ❑ Oeleca(ion ❑ Multiple Family/Condo 0 Warehouse ❑ public Water <br /> ❑ Other: (specify) 0 Public 0 Storage <br /> la <br /> Commercial 0 Other(specify) Private Well <br /> **Any earth movement may require ❑ Industrial <br /> MCWD review&permits. (specify)Creek Watershed District(MCWD) 0 Other: ( P fy) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or• $ ` 4 <br /> Estimated Construction Valuation (excluding land) <br /> Last Updated: 9/29/2009 - 17 - <br />