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�r x�� ��9-C_�� �Q-� -c �C,U1�y^ <br /> � <br /> �'"`` t CITY OF OR�..rNO F�«�i o <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS ,��I� IC�I�,U I �� ���/ <br /> �O� Mailing Address: Permit number: o2D 1 -'b O Z.CI� � <br /> PO Box 66 ' / <br /> � Crystal Bay, MN 55323-0066 Date received: �-R'�'t <br /> StreetAddress:' Received by: d S <br /> y � 2750 Kelley Parkway Plan review fee: <br /> �' � Orono, MN 55356 <br /> `�kFSH��� Total Fee: <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: �"��i J �C;i,� �i C.�'t� � r �'i� <br /> Will this be a Parade of Homes, Remodelers Showcase H me or other Display Home? ❑ Yes No <br /> If yes,a special event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is availa6le. Non-permitted events will not be allowed. <br /> CONTRACTOR/ PP11� FORMATION: t-�-NY�-c����s ,- <br /> Name: ��--�Y1��i l E�� �� Iti1�t.r 1� 5c�t,t��`� <br /> State License# ti j � Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> � <br /> Name: �0.�^ K-- _� �-��'t� ll �:j J�1.���"S __ <br /> Phone (day): ���—�i C� --"7 ?3�i� c.t- <br /> Address: < <' ; E� r, cQ Cit : 1tc� ZIP: �J�;`_j� <br /> Email and/or Fax -`--�,�'; a i S� � c�c, � . c_c�wti <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �.,; � J� <br /> Phone (day): <br /> Address: <br /> r�F„• 71P• <br /> Email and/or Fax: <br /> �_-. I� � �`�- �4� , p : <br /> PROJECT INFORMATION: Description of project: x c_:• � 1��� <br /> 1.Type of Project 2. Proposed Use � ( �� � . al 8 <br /> ��� '���� <br /> ❑ New Construction �Single Family with <br /> �Addition attached garage <br /> ❑Accessory Building ❑ Single Family with - � �' r'� - �-� <br /> ❑ Relocation �, detached garage ��� /„-CJ_I� <br /> ❑ Other. (specify) �"X � •�+�P ❑ Multiple Family/Condo � v� <br /> ❑ Public � �M � S�� �� <br /> ""Any earth movement may also require ❑ Commercial � L�I'►1 <br /> MCWD review&permits. ❑ Industrial � _ � <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) l�� (���(,{� <br /> 18202 Minnetonka Blvd r ��'` <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 � <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or r ' v�' \ <br /> Estimated Construction Valuation (excluding land) � ` l� J�L� . - <br /> c{ <br /> '�c�C�-- .� ��_�� ���-� t ���z�_�� � 'O <br /> q t, L� :F�REA 44a � <br /> `�-o�r,-,�,,r��'-e.,,— �U L�...lo�-�` ��s-MiL�-- -i—i k�,^ _ �x 2,,;,��-$� <br />