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City of Orono <br /> Buifding Perr�it Appiication <br /> for New Structures or Additions <br /> Mailing Address: a0l�—���j I <br /> j�,O,j� PO Box 66 Permit number: <br /> � Crystal Bay, MN 55323-0066 Date received: �� l� <br /> � ��'�k,< O ' • <br /> II � <br /> `',\a °'�'1�-:� �,�, StreetAddress:' Received by: <br /> �\�l� �;� ti� 2750 Kelley Parkway Plan re�iewfee: , � <br /> ��`� g.'�G Orono, MN 55356 <br /> �ESHo;/ oZ�/!- �I.z.�-� <br /> � -- Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This appfication form must be compfeted in full and all required information must be submitted. <br /> fncompfete appfications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �'G�j ��, C��� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a specia/event permit is required with Police Department and City Counci!approva/60 days prror to the evenf. Shuttle bus servrce wil!be <br /> required unless�applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be alfowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: .(�G�.�Niv ��c. .� SP� �c.0 <br /> State License# ' Expirafion Date: <br /> Phone: _ y , q� (ofFice _ c� _ � (cell <br /> Mailing Address: ,v / -rr' Cit : �,�iJ✓�,�ZIP: 6S`/r// <br /> Contact Person: uics oUc: Applicant is: ontrac or / Homeowner (Circle One) <br /> Email and/or Fax: 7G3-Sy)_ c,��,o� <br /> PROPERTY OWNER INFORMATION: - <br /> Name: .,! �G�c.�i�.c �'`� tlC�trpif-����� '6�Z' <br /> � !� lJ <br /> Phone (daY): .��l- � 3 F-����' �� - <br /> Address: � Cit <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATIOf�: <br /> Name: Reason(s) for deniaL• -1�"� <br /> e d aYtA IN�eY O�l10weG� <br /> Phone (day): <br /> Address: <br /> Email and/or Fax: Staff: Dete' �d. . <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Suppfy <br /> ❑ New Construction ❑ Single Family with ❑ Residence <br /> ❑ Addition attached garage ❑ Garage/Accessory Bldg. ❑ Pubiic Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocafion detached garage ❑ Office/Commercial <br /> ❑ Other: (specify) � �'x ❑ Mutti le Famil /Condo ❑ Private Sewer <br /> p y ❑ Warehouse <br /> ❑ Public ❑ Storage ❑ Pubfic Water <br /> "*Any earth movement may require I ❑ Commercial ❑ Other(spec'rfy) <br /> MCWD review 8�permits. � ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed Disfict(MCWD) ❑ Other: (specify) <br /> 18202 Minnetonka Bivd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m innehahacreek.ora <br /> Estimated Construcfion Valuation (excluding land) $ �j <br />