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I <br /> City of Orono ' 1 (i <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number. 0'O/0— 60560 <br /> ��� POBox 66 <br /> 0:1--; <br /> Q Crystal Bay, MN 55323-0066 Date received: 747//v <br /> ' " Received by: <br /> a ,f,,,; Street Address:' <br /> .4'<4.1%:11'1V <br /> .4, •1%Wit'1 V 2750 Kelley Parkway Plan review fe • • <br /> �� �¢�'G Orono, MN 55356 <br /> o <br /> Total Fee: Ola` 7/ <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. (P/ease print) <br /> GENERAL INFORMATION: so �c i, <br /> Job Site Address: , n gyi j& c L&ii e_ <br /> Will this be a Parade of Homes, Remodelers Shov ase Home or other Display Home? ❑ Yes to <br /> if yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus servicewr e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ' //Jil,rtroC) GyLf GZ r. <br /> State License# ._ j. 3.- ,; Expiration Date: '�/cd// <br /> Phone: /,,,2— - ,,L j (office) ,,4.1-9/o - " (cell) <br /> Mailing Address: - 7c , 456�h ..)/vi e /fir-/. City: f l r af ras,d ZIP: 5yf/ <br /> Contact Person: net> Za'h/,)L Applicant is: a o / Homeowner (Circle One) <br /> Email and/or Fax: '/ <br /> PROPERTY OWNER INS VMATa <br /> Name: k �/NC�r�nST�LJc a� ��� <br /> �(i 'IT <br /> Phone(day); LSa ,! <br /> Address: (50 Akr G2 City: d/'ovi G ZIP: 553611 <br /> Email and/or Fax 4, Ca',," <br /> ARCHITECT I 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 /> ❑ New Construction Water Supply <br /> Single Family with _ ❑ Residence <br /> El Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with Deck <br /> AzRelocation Office/Commercial detached garage [Oce/Commercial ❑ Private Sewer <br /> Other: (specify) '.'. * ' 7. ., ❑ Multiple Family/Condo ❑Warehouse <br /> r n 3c y.l e_ (out Public ❑Storage ❑ Public Water <br /> "Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial <br /> El 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: 952-471-0582 <br /> www,minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ 7 SOO <br /> Last Updated; 9/29/2009 <br /> - 17- <br /> 'd DLI ',N S33IA S d3AVdXd1. OH 1/08Y0l OIOZ 'L Mr <br />