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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: ' nn <br /> g,�,� PO Box 66 Permit number: a�� ` C�� (�7` <br /> Crystal Bay, MN 55323-0066 Date received 4—t----1 <br /> f� + Street Address:' <br /> Received by: <br /> �c, �i ,fij G~ <br /> ~ 2750 Kelley Parkway Plan reviewfe�r <br /> �Esz�og� Orono, MN 55356 1A` <br /> -= Total Fee: � l/70 I <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: ,,..11 <br /> Job Site Address: TV Ole CI ✓ (.--u k 4.7 <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.e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANTINFORMATION: <br /> Name: Il d rile_ dJ A ejK <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFOR TION: � / ,.u / V <br /> Name: �; / -+1I <br /> Phone(day): 6-/2 -y 9%-q( z ir-- <br /> Address: fC r.✓c a r-,,, Lane_ S City: O' 7Q ZIP: s-r3S`6' <br /> Email and/or Fax q „,/ e!,,, .,4 r L� ,c ,_ <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: L d wV1Q <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 ❑ Residence <br /> ddition -attached garage ❑ Garage/Accessory Bldg. 0 Public Sewer <br /> ❑Accessory Building ❑ Single Family with Deck <br /> ❑ Relocation detached garage 0 Office/Commercial /Private Sewer <br /> ❑ Other:(specify) 0 Multiple Family/Condo ❑Warehouse \ <br /> ❑ Public ❑Storage 0 Public Water <br /> "*Any earth movement may require ❑ Commercial 0 Other(specify) • <br /> MCWD review&permits. ❑ Industrialrivate Well <br /> Minnehaha Creek Watershed District(MCWD) 0 Other:(specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 G Qpoy-clA�` <br /> Phone: 952-471-0590 +- <br /> Fax: 952-471-0682 1 C j"�\f <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ ?Cod , 0c) <br />