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� � <br /> � � S�,�S <br /> City of Orono � <br /> f�� <br /> Building Permit Application f - � <br /> for New ' ' � <br /> Structures or Additions <br /> ��� Mailing Address: Permit number: OlQ- // <br /> /�,L,�„��\ PO Box 66 <br /> �'� �\ Q\� Crystal Bay, MN 55323-0066 Date received: // /9 /D <br /> �`<,.:<� � <br /> � `'�' I � Received by: � <br /> �� ���'��,�9�4;;;� ��� Street Address: <br /> �L�h�"��f���,����,r 2750 Kelley Parkway Pfan review fee: q� l. 8'9 '/�,I. <br /> kESH�� Orono, MN 55356 a�` ,��� �� �� `' <br /> - Total Fee: /Zi��, <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: � `t Q�- I��Ui�� �j''� l��i-��� 'U 17 (���� 1�-'j l� � 55 35(� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � Nc, <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 i�ll b,� <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 /> State License# Expiration Date: � - �j- �v� Z <br /> Phone: �.,,'�. � �3�- j office �� - -v -�13�U -- cell <br /> Mailing Address: � f '`J(? `('( Cit : E ^ ZIP: S_3� <br /> Contact Person: � E � � �OS Applicant is: ontractor Homeowner (Circle One) <br /> Email and/or Fax: �L - � - <br /> PROPERTY OWNER INFORMATION: <br /> ►�ame: (3G/,�J l'I I � �� � c fftlt <br /> Phone (day): o /�_ - ��(�(�S <br /> Address: Cit : ZIP: t <br /> Email and/or Fax yYt 4 brrZ r �Yl i�2,►� i Vt G'� S � „ C 0 UL'1 <br /> � <br /> ARCHfTECT/ ENGINEER INFORMATION: <br /> Name: ,�A/',./�'�'/V �{f}fv�V' -� ..�Olf/l� �bCS�/GG��-1 , <br /> Phone (daY)� (o I "a- � �5 cU - �'j 30 d --G C�S f- ��f ` �.�� �' <br /> Address: '2 �' G C GCiv � Cit : , ZIP: , <br /> Email and/or Fax: G v � C O <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 /> ❑ 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 <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 or <br /> Estimated Construction Valuation (excluding land) $ 6 00; (,U��� <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />