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T M _ <br /> City of Orono <br /> Building Permit Application , �5 <br /> for New Structures or Additions <br /> Mailing Address: ab/a <br /> PO Box 66 Permit number: <br /> Crystal Bay, MN 55323-0066 Date received: Lo / 2_24 / <br /> •"�'"• Received by: -L //__D�, Street Address:' <br /> G <br /> , • 2750 Kelley Parkway Plan review fee: 37 . 3.2/ <br /> latt.gvog� Orono, MN 55356 <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: 2575 IA/ea r L' v 62 QYD»o, MN 3 5 <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 INFORMATIO <br /> Name: ?cc-LA-CAI <br /> State License# Expiration Date: <br /> Phone: SZ "'1/3 532.b (office) (cell) <br /> Mailing Address: cvn-\i2._ �vQ Cit : <br /> Contact Person: �-�kCao� Applicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: e evc,Th .-4Q n Ca' -(c.v-\OD ,C-0 N_ <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: 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: \). , De C (� <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction 01§ingle Family with ❑ Residence <br /> LlS.Bddition attached garage ❑ Garage/Accessory Bldg. 0 Public Sewer <br /> ❑Accessory Building ❑ Single Family with 'eck <br /> ❑ Relocation detached garage ❑ Office/Commercial /:1 Private Sewer <br /> 0 Other: (specify) ❑ 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.o g <br /> Estimated Construction Valuation (excluding land) $ 1 OO <br /> 1` <br />