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Co-fiLa <br /> • City of Orono S'-(1-L)) <br /> Building Permit Application <br /> for New Structures or Additions <br /> O Mailing Address: Permit number: �DD� 00 Tlo� <br /> Cr Box 66 � WD? <br /> Q Q Crystal Bay, MN 55323-0066 Date received: <br /> A. Street Address:' Received by: <br /> � �, ih . G�ti 2750 Kelley Parkway Plan review fee: <br /> `�xEsxo4`� Orono, MN 55356 <br /> Total Fee: a'O/ a _ 04-) <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: ( L <br /> Job Site Address: 2 00 UJ 6©c� � II Qom_A <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ 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: i ,I f <br /> Name: L ()CALA4 CO � .�"kt2 C.0 u_bI ` Pick (fie .e..2tcU�Se�, <br /> State License# g Expiration Date: <br /> Phone: 9 6-2..-- -03- (/ (office) 6 fa - a 9 0 — S N/o (cell) <br /> Mailing Address: b p o o ; II an vk City: W).2��a ZIP: s"'S-.3 I <br /> Contact Person: ( is tr T24240p..4kLS a Applicant is: Contractor / Homeowner (circle one) <br /> Email and/or Fax: qsa - o3 - 01/ 3 Q...- 2�d4:a.z;<k3 ® M S/0 . Co., <br /> PROPERTY OWNER INFORMATION: l <br /> Name: LL )0 o&\....; 1( Co �...-i� C u.b <br /> Phone (day): '3 - -.S : 7 <br /> Address: a©O (.J tno r 2 00,k_ City: (,t.,J ca.. -z_ ZIP: S.r'�'' <br /> / <br /> Email and/or Fax 4 S ;A60 cJ-e <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 /> ElNew Construction Water Supply <br /> ❑ Single Family with ❑ Residence <br /> ❑Addition attached garage ❑ Garage/Accessory <br /> Ell Accessory Building El Single Family with El Deck <br /> Bldg. ❑ Public Sewer <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> El Other: (specify) El Multiple Family/Condo El Warehouse <br /> CI Private Sewer <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may require ❑ Commercial N.Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) <br /> 18202 Minnetonka Blvd (( CG,..,..4_-\5 <br /> Deephaven, MN 55391 (�CtC` .. <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 e I <br /> ,( <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ / I/ <br /> 000 <br /> -20- <br />