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Y <br /> ♦ �l��� <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number. ��•� <br /> O.g,�,�.0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �,13� <br /> �, StreetAddress:' Received by: <br /> �,�, ���' 2750 Kelley Parkway Plan review fee: <br /> �.q�E�o¢w Orono, MN 55356 <br /> Total Fee: aa/, 7 9 <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: ����' �r ho�` sf <br /> WII this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> ff yes,a special event pem►it is requir�d wifh Police Department and Ci(y Council approval 60 days prior to the ever►t Shuttle bus service will be <br /> required�nless applicant demonstrafes sufficient on-site parking is available. Non permitted ever►ts will not ba allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �rPcr°s�°o v� J�C�''S <br /> State License# a0��'63�oZS F�cpiration Date: 3-3! -aa � <br /> Phone: ��A 3- a a g-y y a y (office) (cell) <br /> Mailing Address: a0 Co� ��� Ci : r�►e fr,'sf ZIP: SS �/ <br /> Contact Person: � v�v�'� Applicant' : Contractor / Homeowner �ci�i�o�e� <br /> Email and/or Fax: ha��'J p5 t�ee/C� Cn� <br /> PROPERTY OWNER INFORMAT{ON: <br /> Name: ��„� �h�� �h��' �arJs o� <br /> Phone(day}: �°�a- Y7S-o�o� ' <br /> Address: ll 4f S y-r+be,r S t City: 6rpc�o ZIP: 55 3 c/ / <br /> Email and/or Fax <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 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 OfficelCommercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑Multipfe Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> ""Any earth movement may require ❑Commercial ❑ Other(specify) <br /> MCWD review 8 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 /> wuwv.minnehahacr�k.o <br /> Estimated Construction Valuation (exciuding land) $ ��5 p� <br /> Last Updated: 6/22/2009 <br /> -19- <br />