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• <br /> a11 I <br /> City of Orono <br /> V� <br /> Building Permit Application <br /> for New Structures or Additions <br /> >_--- Mailing Address: Permit number: (AQla —6:7°1? <br /> PO Box 66 <br /> �� Crystal Bay, MN 55323-0066 Date received: ��1��A <br /> 11 Received by: <br /> ��,A kt,4 :- ,,i; Street Address: <br /> \\1... ` o`i% 2750 Kelley Parkway Plan review fee <br /> r� �_ 7� Orono, MN 55356 'l <br /> k 1-,Yo-.' <br /> �'' 5( <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: d1cR1 e_ 1ne.1 Ro-e- <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes , J 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: br\co Q0_Iio t u:cndot..JS,koul^S <br /> State License# a0co3(4019 .a Expiration Date: 3)2,1I ae13 <br /> Phone: (psi-'I 2-5S-09 4-1') (office) (cell) <br /> Mailing Address: gel 5i-k. Aue. N� a lOO City: ►Jet,: 13ric‘hf-r;-' ZIP: S-s-It a <br /> Contact Person: Chris Ke_}chv l'vl Applicant is: ontracto / Homeowner (Circle One) <br /> Email and/or Fax: Chv tsar Rc:,' coim1. tow' <br /> PROPERTY OWNER INFORMATION: <br /> Name: - Ct.1f C LoY'Q1'I <br /> Phone (day): sI)- '.1% - 9511 /� <br /> Address: Zbci1 tt-hc_t Ave- City: 0fc,1b ZIP: SS39I <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: 1 <br /> Phone (day): <br /> Address: 1►i� P 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 /> ew Construction Sin le Familywith ❑ Residence <br /> Addition attached garage ❑ garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with eck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may require ❑Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial <br /> ❑ 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.orq <br /> Estimated Construction Valuation (excluding land) $ 15i (cc <br />