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' City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> ���_-- Mailing Address: <br /> jg,0,��� PO Box 66 Permit number: <br /> �O :\ O\`�, Crystal Bay, MN 55323-0066 Date received: <br /> � �� <br /> �� � � Received b <br /> a A j ,�' Street Address: y <br /> ��� � �r -,:. <br /> � .�, ������ �ti�'� 2750 Kelley Parkway Plan review fee: <br /> ��kESH�g/ Orono, MN 55356 <br /> - - 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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: Qrj � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> lf 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: C� C�I4 T2U�T�' ON- — Ll_L <br /> State License# �_����L�Z Expiration Date: 1 <br /> Phone: q'Sz-�J'�-�yp,p(� (office) 6�z_�p3-yqyq (celq <br /> Mailing Address: SZ2, p City: — 1�{� ZI : S Z, <br /> Contact Person: p Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: pC��� C,�,��L . Cpvv� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �"�l Cl-�AEL � 1�,0.i 121 LI�'1 -t-�2-N��N'(�C;Z <br /> Phone (day): 6lU- 2�J�3Q3f3(o <br /> Address: z S Cit : pp,� ZIP: <br /> Email and/or Fax MPL..w��a2ivnrv fJ�Z Ac��... • co►� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: (� ,(� <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <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) WIN vW ❑ Multiple Family/Condo ❑Warehouse <br /> M�— ❑ 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.m i n nehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 26 , <br /> Last Updated: 4/26/2011 � <br /> - 19- �,� <br />