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. . � , <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> --_—- Mailing Address , �O � <br /> ;%:�,0,�\., PO Box 66 Permit number: <br /> � <br /> �/Q > Q�� Crystal Bay, MN 55323-0066 Date received: —� <br /> "�%=: ., y <br /> Il�,a ''�"j' ' ,,I� Street Address:' Received by: <br /> ��' �' �'� ti�/ 2750 Kelle Parkwa � G� , g� <br /> \r��;���t�,��� Y Y Plan review fee: <br /> 9 a � Orono, MN 55356 p�p � ��O 3 <br /> ���sxo4`'� <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: ��s ,� ,¢wc �� <br /> Wil� 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: <br /> Name: s%q�Ecvoo p , LLL <br /> State License# 5 Expiration Date: �- 3 f- Jy <br /> • Phone: �j'SZ-471 - oS8 (office) C/Z- ��-ZGlo (cell) <br /> - Mailing Address: L✓A- Z Ti4 &�/0 Cit : , �� ZIP: T S L <br /> • Contact Person: SvEr� �t�5r�F5onJ Applicant is: ractor / Homeowner (Circle One) <br /> � Email and/or Fax: SvcnrJ $�o�tpw000.con1 <br /> PROPERTY OWNER INFORMATION: <br /> Name: Wl�r�- r 1�FEN/i !�i�SNE/� <br /> Phone (day): ��Z_ SsY'- IZ�'L <br /> Address: City: ZIP: <br /> Email and/or Fax ntiK(��55 n er�a '�a koo.c:,o»ti <br /> ARCHITECT/ENGINE�R INFORMATION: <br /> Name: �.��q.N�E�Z �E s,yn1 ���p <br /> Phone (day): � �_ y173_ g77-� <br /> Address: �o/ ��ST !.-.¢�CE 5?�s',�T City: Li/,¢�2•¢T/�- ZIP: `$S3 9'/ <br /> Email and/or Fax: 0.�e�cn�orD�40(.c o„� <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8� <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 /> ❑ 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 (�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) $ C ��'f, dd� <br />