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3 -ZS -12_ <br /> City of Orono <br /> Building Permit Application '6 4 <br /> for New Structures or Additions <br /> Mailing Address: Permit number: f —dd <br /> �,0,4, PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: Z J Z <br /> ,..----.4.13 <br /> � O <br /> u' Received by: " <br /> ,a �, Street Address:' � , f /9 <br /> ��ct'„,,:4;61,24p, 2750 Kelley Parkway Plan review fee: 4 <br /> su Orono, MN 55356 citC/, <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: '/Tvo wz57L Er uAdA "Rd 0 o9,14.49 <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 b <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: <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 INFORMATION: J <br /> Name: o1 --'t-save- <br /> Phone(day): 9Sa a 3Q '?OS <br /> Address: Sow-te.. City: ZIP: <br /> Email and/or Fax )'fl ,rtr,scgp€s G 901tfv) , CAyv” <br /> ARCHITECT/ENGINEER INFORMATI <br /> Name: <br /> Phone(day): v <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Q eLt4y <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> NNew Construction K Single Family with Residence <br /> Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage 0 Office/Commercial -N Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public El Storage ❑ Public Water <br /> "*Any earth movement may require ❑ Commercial El 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) $ L5-7/. C,1Lj <br /> i <br />