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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: c73609- 00737 <br /> PO Box 66 <br /> ‘C‘° <br /> Crystal Bay, MN 55323-0066 Date received: /O 02,o c7 9 <br /> A 1: 1 ., Street Address:‘ Received by: <br /> ��n Il �.' iil � ��� 2750 Kelley Parkway Plan review fee: <br /> t9kE$Hpg�' Orono, MN 55356 <br /> Total Fee: //SD, 96 <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: Li YSS Lk). 6ect..n�� Pd . <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ YesNo <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 w"ill 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: tAx!Icy Cart frcx..+i. IL A-R�pd,'.� 2'•.c <br /> State License# 2 d 3 et? / 9 Expiration Date: <br /> Phone: 9'S� -y6j - 15-7V (office) <br /> Mailing Address: pi,.� X.D 7 City: ��� (°y�-���-a�9`S (cell) <br /> X Y fJ , 01).r fZ - ZIP: SSO 5`t <br /> Contact Person: u L OH-ea/x.1. I Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: o+-1e_,Ja.l.I a /• Ce)sii. 55a-Sf 6 I- Yen <br /> PROPERTY OWNER INFORMATION:t <br /> Name: 51-cvc ne I <br /> Phone (day): 9 5-2,-y72. _ 11 417 <br /> c-J <br /> Address: 4 55 > <br /> t.', ranc k A el . City: 0 ra ne ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): AZ./.-- <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 /> ❑ New Construction Single Family with KResidence Water Supply <br /> ❑Addition attached garage Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation t , detached garage ❑ Office/Commercial <br /> tz Other: (specify) itrla.�wK P ie ❑ Multiple Family/Condo ❑ Private Sewer <br /> p ❑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.orq <br /> Estimated Construction Valuation (excluding land) $ 6, 06c , aci <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />