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City of Orono <br /> Building Permit Application 7 (o, 2 <br /> 5 <br /> for New Structures or Additions <br /> Mailing Address: Permit number: 070//-- U 0 B/ 7 <br /> ‘4,0,�\O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 8/8//f <br /> `'' Received by �Qys <br /> A :'�{ .. 4, Street Address:. Y' "`� <br /> \\t'/,4,1 4a: 2750 Kelley Parkway Plan review fee: 119/. 8 7 joe r"1 <br /> asci`' Orono, MN 55356 ovoN— 008/6 <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,C- &),,((o L-76`€ c #Oy <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <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 ill 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--rb{/�ti� �vc�vl c-e.c .�-vl C- <br /> State License# (9 ci Expiration Date: 3(.2.2r3/ <br /> Phone: 9 5,-1. R g✓`( l p (office) c::? - `�� -- 71( (cell) <br /> Mailing Address: ( r ' r" City' Caen ZIP: c-3-5-3-(7 <br /> Contact Person: \ vv, (...k.. ',, �gc_(-... Applicant is: ':" _ . / Homeowner (Circle One) <br /> Email and/or Fax: 3 ,./\- c (i\cwtti e___ -1A-- o_)&c_e cf r , COPROPERTY OWNER I�VFORMATIOIV: n (I <br /> Name: `, p � , ��r <br /> ' l-e'r_ 5- Ko p <br /> Phone (day): "5- _ 7�7 <br /> Address: '/,S /.o ;( o ( .2cv E/K-' City roc ZIP: c• *---5113 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 /> Water Supply <br /> ❑ New Construction ❑ Single Family with Residence <br /> ❑Addition attached garage Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> Relocation - detached garage ❑ Office/Commercial ❑ Private Sewer <br /> Other: (specify) 52 ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> 'Any earth movement may require ❑ Commercial ❑ 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) $ ,,.Q 0 , <br />