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• <br /> r' 0,\0 City City of Orono43/. 7 <br /> \`\N Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: , gaa ze-7Q?' <br /> �i►0� r Box 66 <br /> -Q Cry <br /> \ Cstal Bay, MN 55323-0066 Date received: /0//, <br /> '_ .v,.- <br /> a. �.;.' �, Street Address:' Received by: <br /> �,A� <br /> 1�n tiY^� � GAF' 2750 Kelley Parkway Plan review f e: <br /> t`�kEsxo4`� Orono, MN 55356 <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us ,0 --0, 474%.=D <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: 702 0 (.c) li t -e Oct. C 112c.)e <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes "R"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: ff <br /> Name: 'BR\AA). �S�epineYtQ ) Coast, ..T.A)C <br /> State License# c,?Og,,`,,145? E iration Date: g-6 J—Ro id <br /> Phone: 7/ ? -4/2g—‘,_5oa (office) /,,, --5•5-7-0,/-7-7 (cell) <br /> Mailing Address: c2 ) j- '/P"1-1„4,ver R,i City: tN4 ZIP: ,_4-5-3r/p <br /> Contact Person: BRI/1-.,-) r54-epiiertSo.t4 Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: c <br /> Name: Citri-i die. c Em.1( Ike l)e1 <br /> Phone (day): 9So2- ,'7,3-- ).236 <br /> Address: ,--7,;70 tt)it•i- ekt k- Ci)Ze-[e City: <br /> Email and/or Fax OR/0/06 ZIP: <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 /> ❑ New Construction Single Familywith Water Supply <br /> 9 Residence <br /> Addition attached garage ❑ Garage/Accessory <br /> ❑Accessory Building ❑ Single Family with ❑ DeckBldg. ❑ Public Sewer <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> ❑ Other: (specify) ❑ Multiple Family/Condo Private Sewer <br /> P El <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review& permits. ❑ Industrial <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) Private Well <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) $ A.5—e3 000 =o <br /> Last Updated: 9/29/2009 <br /> - 17- <br />