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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> C6-t ��\ Mailing Address: Permit number: <br /> °.(�\ PO Box 66 oZ�O d0�,�5� <br /> \\ Crystal Bay, MN 55323-0066 Date received: W5/129 <br /> Lk <br /> �Y <br /> 4 t Received <br /> ��i �;,,,=, , a Street Address:' by: <br /> lit i, it ` c'. 2750 Kelley Parkway Plan review fee: <br /> �Esxos�`v 076, <br /> Orono, MN 55356 <br /> Total Fee: �� J <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us (S79- / 6� <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) J�/ <br /> GENERAL INFORMATION: <br /> Job Site Address: ZS c ° l,,�oc"ON vr_,-a wellyE ` 0it-ci IG <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes Z 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: 1aI(S7- pouaTr 0-6mGVi=c.in1t, <br /> State License# Zp(o 1Z 8 14 Expiration Date: 3/31 /Z0/o <br /> Phone: (451j q44 -(PB33 (office) (cell) <br /> Mailing Address: Z(05" CQl=sivti ave Ci Q(�2o�to ZIP: 5535 C. <br /> Contact Person: eoz.(,J pi_iER.50 4 Applicant is• Contractor) / Homeowner (Circle One) <br /> Email and/or Fax: RoLA,4 L tur_5T—P0i1-1-6-91--Moo r IN6 -co,'C <br /> PROPERTY OWNER INFORMATION: <br /> Name: TODD HYDE- <br /> Phone <br /> DEPhone (day): 45Z.) -1101 40 5 to <br /> • <br /> Address: &SOO I,uWAY}(INV 11M Drzl.rt_ City: Cc tc ZIP: /'[Al <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 /> 31 Relocation detached garage CI Office/Commercial CIPrivate Sewer <br /> Other: (specify) ODIN11,9 >✓.XT ST,I(6510' ❑ Multiple Family/Condo ❑Warehouse <br /> Qom ❑ 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) $ 2.5 0 d <br /> -20- <br />