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City of Orono <br /> Building Permit Application 7 &, ?-5 <br /> for New Structures or Additions <br /> Mailing Address: <br /> �v O,jV PO Box 66 Permit number. (:).26//— U° 7 <br /> l�II Crystal Bay, MN 55323-0066 Date received: 8,448//f <br /> a a,Ji <br /> Street Address:' Received by: S <br /> ''S'1,17tjt,,-7:-.. <br /> " .otic'/ 2750 Kelley ParkwayPlan review#ee 7�9/. �„ ogOrono, MN 55356 p/ - e081 67 <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: '96'5— C-(),'((o c (:);.e c L1y <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <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 ill be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed. <br /> CONTRACTOR/APP ICANT INFORMATION: <br /> Name: v f/v,_ _,n .c�tti.c e.r.S S-vt -.— <br /> State License# t 4-(c-- Expiration Date: 3(.2._6 f <br /> Phone: 4b 5 ; 1 - I. — office - , <br /> __ cell <br /> Mailing Address: ( (,"1'' (' .ems_ A - City ',,.. ......C.:,pe ZIP: s--5--3-z ? <br /> Contact Person: ,i\Irk,- L. ;c i,_gc_l-... Applicant is: ,.:ntrac • / Homeowner (Circle One) <br /> Email and/or Fax: J ii‘o , _ ((\_wV\.e— _,A ,n`6.-.VLce_cr r , C____(:-_) psi\ <br /> PROPERTY OWNER I FORMATION: f� <br /> Name: ' -'A �( <br /> b6,_ V t---; .Lr-_,,,- <br /> Phone (day): ”gra _ 7 7 <br /> Address: 'G <br /> .S 1-e J ( o ( r.2c.v f9p City0 (e,,r\c ZIP: ���T3 .57 <br /> Email and/or Fax <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 /> 0 New Construction Water Supply <br /> ❑ Single Family with Residence <br /> 0 Addition attached garage Garage/Accessory Bldg. 0 Public Sewer <br /> 0 Accessory Building 0 Single Family with ❑ Deck <br /> ❑ Relocationdetached garage 0 Office/Commercial 0 Private Sewer <br /> Other: (specify) ii1.3...5e_vq\.-e-0,-k--- <br /> 0 Multiple Family/Condo 0 Warehouse <br /> 0 Public 0 Storage ❑ Public Water <br /> *"Any earth movement may require ❑ Commercial 0 Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 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) $ ,,p 00Q :---- <br />