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• Cit of Orono ` , � <br /> Y <br /> Building Permit Application <br /> for New Structures or Additions / <br /> Mailing Address: Permit number: (.9913 -0/6 3✓ <br /> (/o Cr Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: /6-1;11-13 <br /> ,� �` I <br /> Street Address:' Received by: <br /> �F, kes 2750 Kelley ParkwayPlan review fee: <br /> ��kESH�t' Orono, MN 55356 <br /> Total Fee: p 95-4:z <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us KK <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: 97S- & ' �c 7•:--a......-"( Cr-'er-,z---in <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other 6isplay Home? ❑ Yes Qj 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/APPLINT INFORMATION: <br /> Name: X1.1 .o,,.5. re --Cd a=6,_,-.+4.L1-'7 <br /> State License# Expiration Date: <br /> Phone: 95-2- y7 i /p;7 (office) 6 r i 3 s 8 Z.-4.00 (cell) <br /> Mailing Address: 775.- 6.0,ld se— 7.--4,....2, City: 0,,„..„,_,r IP: 541-3 Ca c f <br /> Contact Person: T.ul c-5.6 de%-c�y Applicant is: Contractor / ome neF-3 (Circle One) <br /> Email and/or Fax: J <br /> PROPERTY OWNER INFORMATION: <br /> Name: --A,.,. I _f odc."..cL4.- <br /> Phone (day): l(-Z -3( z 9 2-4ffO <br /> Address: 97 6�e1 �,v,74- r - ' City: /2Co-c.,,� ZIP: S J 34 <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: ,f-lo a <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 /> ❑ New Construction Single Family with igResidence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. 'ublic Sewer <br /> O Accessory Building flA0 Single Family with 1=1 Deck <br /> ❑ Relocation detached CSP detached garage ❑ Office/Commercial ❑ Private Sewer <br /> Other:(specify) e ms/ deck ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **A y earth movement may require 0 Commercial El Other(specify) <br /> MCWD review&permits. 0 Industrial 0 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) $ /..,--.2 o <br /> Packet Last Updated: 10-20-2011 • <br /> -20 - <br />