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f � <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: OZ�I�'��� <br /> /�,O,j�.� PO Box 66 <br /> / Q .0 O Crystal Bay, MN 55323-0066 Date received: � /L <br /> �� � l <br /> `�a �"'�j� :` >,�; Street Address:� Received by: <br /> \�' �� � �� 2750 Kelle Parkwa � <br /> \t�5x�,� Y Y Pfan reviewfee: , <br /> ��-`� '� Orono, MN 55356 _9 ,/ <br /> �_..ESH�. l�0/!— O/Z`-� � <br /> ----� Tota1 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 appiications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �'/G�j ��, �� <br /> Will this be a Parade of Homes, Remodeters Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a specra!event permit is required with Pofice Department and City Council approva160 days prior to the event. Shuttle bus service wil!be <br /> requrred unless�appticant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: ��G�.ANiv ,�c�c � Sp�J 2'�.t" <br /> State License# Expiration Date: <br /> Phone: y - � ofFice _ c� _ 3 (cell <br /> Mai(ing Address: ,v / �' Cit : �a,��J,�.�ZIP: �,S'�!C// <br /> Contact Person: uics Oc�Gr App(icant is: ontrac or / Homeowner (Circle One) <br /> Email and/or Fax: '7G3-Sy>_ �boG <br /> PROPERTY OWNER INFORMATION: <br /> Name: _�� ,! �c.c.c-i.�.c C�!'`� —�iCation-��1�1'��Z <br /> !� 'IJ• <br /> Phone (day): �`5 j- � 3 F-���� _=_ <br /> Address � Cit <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: Reason(s) for denfal: 1�� (� <br /> Name: px tL� hard �N�weGl <br /> Phone (day): <br /> Address: <br /> Email and/or Fax: Staff: Date: �. . <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 8� 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 Construcfion Valuation (excluding land) $ � <br />