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- s . <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> �--� Mailing Address: Permit number. ��' !C - C'�C -733 <br /> �,0� PO Box66 � - I�— 'U <br /> O , '��� Crystal Bay, MN 55323-0066 Date received: <br /> ,� '��� �,� Street Address:' � Received by: 1�� l�-�i �L � <br /> �_�.�, ,�,�' � ,�� �ti�' 2750 Kelley Parkway�����3_ po � Plan review fee: �=-���� "��C' �'�� ��j/"� y.�� <br /> '�9kESK�� Orono, MN 55356 <br /> _>_:... ��i -4-c' <br /> — y ��' T I Fee: �� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �,�c., . �, ,�� . <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: 33 8'Z- l3A 5��� o,cLp <br /> Will 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 Counci/approva!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: C.µAR�•E5 Cuo►� - Dt.N�vo <br /> State License# 20 !c 3 S 2¢S Expiration Date: 3 - 3 I- ZOI� <br /> Phone: folZ - 359- /709 (office) �/Z_ 4.qp - 7�¢Z (cell) <br /> Mailing Address: - a� ��� , Cit : �L`(1H0 T)-� ZIP: S"S <br /> Contact Person: S�-vE, L�c�-LT Applicant is: on / Homeowner (CircleOne) <br /> Email and/or Fax: SLicl-�1� 2 CNARL�-ScUDi� . r o� <br /> PROPERTY OWNER INFORMATION: `,��p��"L �-�fKJ GUdGI��-� <br /> Name: Ic.. A.� J- M�4.ttl C.`fl�.t N u Ti-4 fi�(.�4!T"'� <br /> Phone (day): <br /> Address: City: ZI P: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: E5K U GN�E CRE•ts.'r'�VE �R.oca P <br /> Phone (day): ��Z - Zq[n - -jS 7S <br /> Address: Z.o1Z /�tD�AI� 2ta�4D City: /Y1�Nl�lETbtiJKaZ�P� 5S30S <br /> Email and/or Fax: ��/pp e ]'iME(..ESS,42C/�l7""EcT�. Co/v1 ___ __ <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4.Sew �s D :,�p �a; & <br /> WatE�����?!y <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 8�permits. ❑ Industrial ffi Private Well — �� <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) <br /> 18202 Minnetonka Blvd L'p�p�'�P�N� <br /> Deephaven, MN 55391 ��2,�ts/�T10N <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 d N LY <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ '7l0 5,. 310,3 . `� <br /> Last Updated: 9/29/2009 <br /> - 17- <br />