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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> —�` Mailing Address: Permit number: ab II—61)72-1 <br /> 0,7\ Cr Box 66 <br /> Crystal Bay, MN 55323 0066 Date received: 7-ZS- /(A !'s*-. fit,.» Street Address:- Received by: 66 5(-Ole* <br /> ,�, i ; Gti� 2750 Kelley Parkway .Plan review fee: 37 3 , U, pd GC— <br /> \t <br /> g� Orono, MN 55356 <br /> � EsHo ao/l 0072.0 <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: _. /,?/ / '1°---- r i <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? n Yes 1 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: = %�1/1l) 11 SVS(Vi "1 /NC- . <br /> State License# 7252. Expiration Date: ?jr Si 12. <br /> Phone: —1•7$.- 12 2!J (office) (cell) <br /> Mailing Address: / //q onet v� � tirci1 . City: OiWole/lth kg ZIP: Z3¢,$- <br /> Contact Person: atVpke,.. Applicant is: o rac oy / Homeowner (Circle One) <br /> Email and/or Fax: ej e 1'SL/}i ,b 4/2cH • C,0II14 <br /> PROPERTY OWNER INFORMATION: <br /> Name: Gt f�GG/ fCC[� <br /> 4GI <br /> Phone(day): 9 — "AL`,- — ,'i <br /> Address: '3 wool( /y / - Roil c City:aV)fO ZIP: �Tj,9r <br /> eliEmail and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATIO <br /> Name: if-e8140/0 V12llf/bl / in{_, <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 /> FAccessory Building ❑ Single Family with ❑ Deck <br /> Relocation detached garage ❑ Office/Commercial <br /> ❑ Other: (specify) ❑ Private Sewer <br /> ❑ Multiple Family/Condo p Warehouse <br /> ❑ Public of Storage ❑ Public Water <br /> *"Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review& permits. f Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) Other�pecify) <br /> 18202 Minnetonka Blvd C�1(/!►'/'l <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ 40,i9a6 <br />