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0 . %__ - i / 7 5(,a 75 <br /> City of Orono <br /> w Building Permit Application <br /> for New Structures or Additions <br /> - ;� Mailing Address: Permit number: <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Received b <br /> a ^` �' a, Street Address:' Y <br /> 2750 Kelley Parkway Plan review fee: <br /> \t', `og�G Orono, MN 55356 <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 /> GENERAL INFORMATION: Incomplete applications will be returned. (Please print) <br /> Job Site Address: �_� Z,5- vu*�2A�- jZ-vo <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes <br /> /f 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: <br /> Name: (�1 C�n� ivi u o> (►�)�, <br /> State License# Expiration Date: <br /> Phone: Ce t2. L+9 2, (office) (cell) <br /> Mailing Address: t5b so, pTb ST Sit 00 Cit : �--s ZIP: SS 14 <br /> Contact Person: -�lAs(LbL FbF_r1$ Applicant is: ontractor Homeowner (circle one) <br /> Email and/or Fax: hAR-V-.Fo'P-0 L (L�(itN��►��G�i1�.S.��"'I <br /> PROPERTY OWNER <br /> INFORMATION: <br /> Name: c-nm VS p-e- <br /> Phone(day): CQ 12_It-I z. g g 1 <br /> Address: SAME " hie is City: ZIP: <br /> Email and/or Fax ��� t(,�t�ljCNS�, c� �t�,4�vLp��,It�1 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: A-4 <br /> Phone(day): cp(z_ L(---+C2...� p <br /> Address: City: ZIP: <br /> Email and/or Fax: 1J4-,-i'E. ►( 1t_� <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> ❑ New ConstructionWater Supply <br /> ❑ Single Family with El Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. 02'15'ublic Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> ❑ Private Sewer <br /> EQ/Other:(specify) I"fie' IZ- ❑ Multiple Family/Condo [! arehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> 'Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. 9-rnndustrial &INI ❑ 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.or <br /> Estimated Construction Valuation (excluding land) $ 2-gopis) <br />