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• <br /> • City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: ' <br /> Permit number: <br /> G /(74-"C/ 3 <br /> ("WAfr \ PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: ///�-'(.-//t� <br /> 1 Street Address:. Received by: -1?(-) _ <br /> J 2750 Kelley Parkway E rQ 7 / S' `L 34-0-2"------N <br /> Plan review fee: <br /> __?(I\A-;:.- <br /> F Orono, MN 55356 l / ,/0'0�( I i <br /> `IkFSH00' Main: 952-259-4600 TCita ee: - <br /> 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: (0'25 F.eg/JD*LE /© i /Vo-le T7+ <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 I APPLICANT INFORMATION: <br /> Name: Lee-C Pdt?eirrik 3 '1 147t4? AQ�'`fo--V ez-IA-L' <br /> State License# ,3 G-3 2�- --$S' Expiration Date: -3/3t //6, <br /> Phone: (Galli Ditx7' gs2--`7% -37$ 3 (office) g 2- (<ylc/— q 4 99 <br /> Mailing Address: /501-2_ rti 6,hturtf r}' City:It,aiivarit+s4<' ZIP: 34},5-- <br /> Contact Person: //4/t( •""' nrAi-ntit/ Applicant is: (Contractors / Homeowner (Circle One) <br /> Email and/or Fax: r 1!>° 1—, .e t *► — O <br /> PROPERTY OWNER INFORMATION: <br /> Name: GA/Zs 0-11) At-AV 1'i4 i B Li ;- i) 6,L4j <br /> Phone (day): x'](03- 2.21-- Lf 1/ (a so J) <br /> 42 <br /> Address: 5' �Arr2/14,1 L&- w/Q,p 10B72_n-f' City:ipltc(- - ZIP: 5-5- 7/ <br /> Email and/or Fax cf}-1:?g0,4v[G-s D 6 c.,42C.cFL, ,c_044 <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: A)14- <br /> Phone (day): <br /> Address: _ City: ZIP: <br /> Email and/or Fax: <br /> A-ran AAP s2iTi .J err Tiler- <br /> PROJECT INFORMATION: Description of project:Ram c0 - biTilettO&-0e2xectxt kiwis/143,vtt1c/t/ k)crt.g,gezfr <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal & 3b <br /> Water Supply &rnibetteer <br /> ❑ New Construction ®Single Family with NI Residence ST,tZL, <br /> Addition attached garage N Garage/Accessory Bldg. ❑ Public Sewer <br /> Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ►_ Private Sewer <br /> ►� Other: (specify) t IUTer?..102 ❑ Multiple Family/Condo ❑Warehouse <br /> R4%7141)1geL ❑ Public ❑ Storage <br /> ❑ Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial x 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.or. <br /> Estimated Construction Valuation (excluding land) $ 2 501 0670 <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />