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A w <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: 2-CC'q -CC (` <br /> Og,0,� PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: (_( - i`3- DC) <br /> Receive y: Jul <br /> a a Street Address:' Pod /Z <br /> ���, i?(+, 'l "' ctiti 2750 Kelley Parkway 11-` q -- OC�O p'lah review fee: I �+(r1 . Rcl <br /> P() <br /> \\\� og� Orono, MN 55356 1 <br /> fix 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: 70 WEA is LiM'E <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: GoitboA) 5'cir'tE5 Co.4STR(ACT.ro•J <br /> State License# o?OS 3 t 96, I Expiration Date: "MCA/ .2010 <br /> Phone: O?c.3)£4' -3/1 7 (office) (cell) <br /> Mailing Address: 5is9 Om LA) sT E P9.BoX 3o 6, City: "'PIE P[Ar.c) ZIP: 5.5.359 <br /> Contact Person: "ToE elcPNErtso-✓ Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/Or Fax: Joo gprdein- .i.r.,rs. cern 4'993)'474- 3g g <br /> PROPERTY OWNER INFORMATION: <br /> Name: �44 5 S ?FE S FF F IZ <br /> Phone (day): (gsay'7(-a?144 <br /> Address: City: ZIP: <br /> Email and/or Fax J • <br /> en(;wso., Q yalcoo . covi <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: 4dol.o.vayA4be pE5r6•v 6RouP <br /> Phone (day): (4s.2) .?4o - 9S43 <br /> Address: /84,S3 PO4)6E40SN CT. City: IAEA, P.tgsesE ZIP: SS34`7 <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 /> igNew Construction Jg Single Family with igResidence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial g Private Sewer <br /> ❑ 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 y[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.orq <br /> Estimated Construction Valuation (excluding land) $ 350,o o — <br /> Last Updated: 5/21/2009 <br /> -20- <br />