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wufrikir I <br /> AAP4;-1 .5.' l�L <br /> City of Orono �� <br /> _5 <br /> Building Permit Application � l�� 3 -7.7 <br /> for New Structures or Additions - <br /> Mailing Address: �i3—CV 0.7 <br /> (. 1.04,...--c-- <br /> CrystalPO Box 66Permit number: f Bay, MN 55323 0066 Date received: /y ��,I Street Address:' Receivedby; <br /> t roti 2750 Kelley Parkway Plan reviewfee: i " <br /> Orono, MN 55356 <br /> ./9 '''' I <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. i <br /> Incomplete applications will be returned. (Please print) ESC re-eCU <br /> GENERAL INFORMATION: C f (p -I0-13 <br /> Job Site Address: / <br /> C Wet r L- h l -> Cr ilvj .4"�4 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yeslo <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 Ae <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION:cl/ J <br /> Name: CA&rrl L I d S <br /> State License# ,fr_6�p�/(.(. /-e„c( y`,i/„L IT/ 7 Expiration Date: 6'--'- ?c/? <br /> Phone: 7 —4-1g--?-21y (office) (cell) <br /> Mailing Address: 3i`1 Q y v,_ 5. 010 City: &V;9(�2ttr/,r ZIP: 5'5'- 7/ <br /> Contact Person: ,tf,-1-,--.-1 >di,ys&Ax + Applicant is: Contra for / Homeowner (circle One) <br /> Gt <br /> Email and/or Fax: ,,f t, 6)�j`tP[,0(,H.....�{nt f cLc, cuvv� <br /> PROPERTY OWNER INFORMATION: V i " /./ <br /> Name: C/ r,( / -1 <br /> Phone (day): G/)- y yyZ <br /> Address: gj Weil,- Lwr� 5, City: d��'!d /tl,/ ZIP: C-3 <br /> SEmail and/or Fax a 6)ye-4 Y , 01-7,-,- <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <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 /> •-•• _ . struction ASingle Family withResidence <br /> R'Additipn—y attached garage [•Garage/Accessory Bldg. ❑ Public Sewer <br /> ccessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "'`Any earth movement may require ❑ Commercial El Other(specify) <br /> MCWD review&permits. ❑ Industrial Q�Private Well <br /> Minnehaha Creek Watershed District(MCWD) 1= Other: (specify) /\ <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.org <br /> Estimated Construction Valuation (excluding land) $ /N(f(0 00 , 0 0 <br />