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� <br /> ' b�l� <br /> City of Orono �\ � <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: o�D/�-j�fd 9/ <br /> g,�,�\ PO Box 66 <br /> 0 , o\� Crystal Bay, MN 55323-0066 Date received: // d9 /� <br /> � �s��T � <br /> .� t�'. -,�-��" s, Street Address:' Received by: <br /> s �,�� <br /> �'�,nt� ' n�r �� 2750 Kelley Parkway Plan review fee: <br /> 9kESfI04'� Orono, MN 55356 <br /> _ Total Fee: � / ��� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us /( �-d� <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete appfications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � �, ��, � �,� � � �� �:�_�S� c� ( <br /> Will this be a Parade of o- I�mes, Remodelers Showca�e om�or�other Display Home? ❑ Yes � No <br /> If yes, a specra!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 suffrcient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLIC�NT I FORMATION: <br /> Name: 1� , � ,�� �� f�u � <br /> State License# Expiration Date: <br /> Phone: C��� - .E�� - ��; ���Y ,(office) (cell) <br /> Mailing Address: � 2 Cit : ZIP: S- -- <br /> Contact Person: + Applicant is: Contracto / Homeowner (Circle One) <br /> Email and/or Fax: � ( p,�,, ' / �r���L�.� <br /> h`�LC,v',.��rJc���, c�, <br /> PROPERTY OWNER INFORMATION: <br /> Name: �j; ( ( �-,n � �5 c ,-� <br /> Phone (daY)� !v� ;� - t�L�c�-(���,�� <br /> Address: ��1��5 j�c. la��t � ���� i�� City:�J��. � ZIP: S l 3 `r� <br /> Email and/or Fax ��,!���f�,������_Q�� '����E ����,� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Na��ne: L��v� /�;c�`� r� <br /> Phone da �`"`l �� c <br /> ( Y)� �1�3 - (ofSZ kS3c� <br /> Address: ;�3�s� C��� ,� �e r1%�, City�u ��/�; ZIP: �-�-�{T_ <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 /> ❑ 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) �0�,��-��r f cPci�� ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> ""`Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review 8�permits. ❑ fndustrial �--o�nn�c�cn Rc�,� ❑ 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) $ �' �3�pp �--�c,�'►�,o( p� ��� <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />