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t <br /> City of Orono <br /> Building Permit Application , (i7 <br /> for New Structures or Additions , 061(4g3 <br /> Mailing Address: Permit number: OXV/A-01:7 tolOterit <br /> 0— .4- c:) PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 5- <br /> -4-,ib ' `3. __ ›,, Street Address:' Received by: <br /> `. 1 ' ;l s Gtiti 2750 Kelley Parkway Plan review fee: 04 <br /> L9kESH04� Orono, MN 55356 060/6 —00 X59 <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: g� Gil,/1O4/ 1/;Cr-✓ I)f?i a6----- <br /> Will <br /> 6Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes u-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/APPLICANT INFORMATION: <br /> Name: [;RE/J/J' 2vopPr-1-1r_ <br /> State License# ao3 31y I a Expiration Date: 3! i 3 <br /> Phone: to;i---(0;,4,.— -{Li'-I-7 (office) (cell) <br /> Mailing Address: 1�cr,' Q FL.;/1- Po,,,1¢- i City:pc,,,i (1;,C ' ZIP: 3 73 <br /> Contact Person: Joe t rC ri el, +-� Applicant is:—eonrtrac / Homeowner (Circle One) <br /> Email and/or Fax: q3-2 -- F_..rf: - N/ <br /> PROPERTY OWNER INFORMATION: <br /> Name: t� �� LCe_Dca<.,+--; Ate, <br /> Phone (day): Co CZ- (Q On -- --o 'ill <br /> Address: c[c— (..--'1110 Ili-,'.--, 0(i ye City: 0 -.),,.j ZIP: <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: F.2i(.1.)449-� / ,i,i4fr% (,'✓i `'r)ci/' 7' . <br /> 1.Type of Project 2.Proposed Use --) 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction ®Single Family with G'' Residence <br /> 111 Addition attached garage ❑ Garage/Accessory Bldg. 0 Public Sewer <br /> Accessory Building 0 Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> El Other: (specify) El Multiple Family/Condo El Warehouse <br /> El Public ❑ Storage ❑ Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ 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) $ i 000 <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />