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• <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> =� Mailing Address: p�rmlt number: <br /> O,� PO Box 66 <br /> } Crystal Bay, MN 55323-0066 ,Date received• <br /> A a"i; t, a. Street Address:' iReceived by <br /> \ikES1�t !1 •+ ' Gtiti 2750 Kelley Parkway Planiereview fee: <br /> Ho Orono, MN 55356 <br /> 4 <br /> ___=___,-- <br /> ____ <br /> - Total F.ee • <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: I 2g7 \� Id��r 1 ��� <br /> Job Site Address: i Ul <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 be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be all//owed. <br /> CONTRACTOR/APPLICANT INFORMATION: 'L�� ! � <br /> Name: c7/ jetvekL" € , F'��EP-e_X 1x... ue7 h` ;.1d' <br /> State License# 3 e 3 1 t'S/ Expiration Date: O ' / ' <br /> Phone: E(2 -2 k 5--21 6 (office) ((cell) <br /> Mailing Address: 3/S0 .g f-Q iC : Ay�t./ ZIP: ''- -5` 12 j <br /> Contact Person: A £els" /JVP �O vim-/ Applicant is: VContrador / Homeowner (Circle One) <br /> Email and/or Fax: <br /> Name: <br /> ERTY OWNER RM'TION i , df'e (4 / <br /> Phone(day): /, � t, /G(;) <br /> /'/ep� G <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> • <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 El sidence <br /> El Addition /,, attached garage arage/Accessory Bldg. El Public Sewer <br /> ❑Accessory Building �"Y - � ❑ Single Family with Deck <br /> ❑ Relocation da-4- <br /> detached garage El Office/Commercial <br /> ❑ Other:(specify) i - 4+I.vt ❑ Private Sewer <br /> ❑ Multiple Family/Condo ElWarehouse <br /> S kat I3 El Public ❑ Storage El Public Water <br /> "*Any earth movement may require ❑ Commercial El Other(specify) <br /> MCWD review&permits. ❑ Industrial <br /> El Private Well <br /> Minnehaha Creek Watershed District(MCWD) 1:1Other:(specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq f� <br /> Estimated Construction Valuation (excluding land) $ oG ga° <br />