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. <br /> City of Orono ���a, �S <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: O/o� q <br /> /-.�j,��,�.� PO Box 66 Permit number. a ��� � <br /> �� �\ � Crystal Bay, MN 55323-0066 Date received: 9`7'� <br /> �' '� n` i i ,�� Received by: � <br /> �,� �✓J�l,�-:'.� �,;; � Street Address:� <br /> '� ,`�., �'.'��Rw�� �ti'' � ' 2750 Kelley Parkway Plan review fee: —l�� � <br /> \\'�xESKog� � Orono, MN 55356 �� <br /> `_-—= Total Fee: � �L <br /> Main: 952-249-4600 Fax: 952-249-4616 www ci.orono.mn.us Lcj(j�j � , <br /> This application form must be completed in full and all required information must b mitted. 20t2_('��C�(p1 <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �1�J �JA.�5�i�c 1��-� <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 Council approval 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: -1 � � T �-v2 S -�z�lu ll��- <br /> State License# Expiration Date: � j j�( <br /> Phone: �fyj'Z - �/�'� -�c'�O (office) COi�—3(�a(v' (ol�I (cell) <br /> Mailing Address "'� �3� Cit : � , ZIP: �- <br /> Contact Person: ��c,.�,rL-TN'c ' �µ, `V Applicant is: ontrac o / Homeowner (Circle One) <br /> Email and/or Fax. �t�y t�r � {�c?�t�tt-G'irta��c.rl�'�j'JOh'l,G'S, ����►�'� <br /> PROPERTY OWNER INFORMATION: <br /> Name: y ��C-� �Jc�ut-►� <br /> Phone (day): - 20-� <br /> Address: City: ZIP: <br /> Email and/or Fax --tvbi hc�J`�� �' G2AL GDYn <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �U hG�..� rj�-{'1n.2_ <br /> Phone (day): [o�J -1.��J�� ��5�, <br /> Address: c. �i' Cit : �U,r,ati: ZIP: �i <br /> Email and/or Fax: �j � :-/�3�-� �(� <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 �,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) $ �J�J�t Uc��' c� <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />