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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: d/Z}�jd <br /> O�,D,�.O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �� <br /> ���'`' Received by: <br /> ,� �'��`±�� �, Stieet Address:' <br /> '�',�, ,���� Gti�' 2750 Kelley ParkwaY Plan review fee: <br /> �yk�Kog� Orono, MN 55356 <br /> -- Total Fee: <br /> M2111: 952-249-4600 FaX: 952-24913616 �-�^.MA%CI!>rflnn rpn ��s <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 Slte Add S8: L 't,' �, '� �� �� � ''� � �� <br /> Will this be Parade of Homes emodelers Showcase Home or other Display Home? Yes No <br /> If yes, a special e � is require with Police Department and City Council approval 60 days pnor to the event. Shu e bus service will be <br /> required un/ess applicant demonstrates su�cient on-site parking is availa6le. Non-permitted events will not be allowed. <br /> � CONTRACTOR/APPLICANT INFORMATION: <br /> Name: gEN•1 J�I�I �r•J l�-!IL�Z./�A 7"t-f <br /> State License# Expiration Date: <br /> Phone: office 2- , S -- ;� cell <br /> Mailing Address: Z� �i t�C""� � U U L - Cit : ` j� ' 6. IP: �j • <br /> Contact Person: � � Z- Si� - pplicant is: Contractor / omeown �ci.cie o�e� <br /> Email and/or Fax: ;i 'JUC, - L -� L � � �� " < <^ <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��v'� <br /> Phone(day): - <br /> Address: _ ' Cit : c;� ZIP: U � <br /> Email and/or Fax '' � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): ^ �� - <br /> Address: L. '� Cit : ' '��' � „ ' ZIP: j 5.3 .5 <br /> Email and/or Fax: G S ' <br /> PROJECT INFORMATION: <br /> 7.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:(speafy) ❑Multiple 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 Bfvd <br /> Deephaven,MN 55391 <br /> Phone: 952�71-0590 <br /> Fax: 952�{71-0682 <br /> www.minnehahac .o <br /> Estimated Construction Valuation(excluding land) $ ����,�,v�"'- <br /> Last Updated: 9/29/2009 <br /> - 17- <br />