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. � <br /> - �T�` <br /> _ � � <br /> � � <br /> C�ty of Orono � <br /> � i <br /> Building Permit Application � <br /> for New Structures or Additions <br /> Mailing Address: Permit number. t����'OG Z�3� <br /> %�,�,�� PO Box 66 � <br /> � Crystal Bay, MN 55323-0066 Date received: /—/C �/3 <br /> 0 � 0\ � <br /> � k I <br /> a '�'�l�,� {`:_ a�;' Street Address' �_ � ' -_- <br /> '�'�c,�;���,����,, �ti� 2750 Kelley Park �p C 3�-�L� Plan review fee: ��l• � '��C� � <br /> ����s�o�,�,� Orono, MN 55356 _ <br /> '" Tots Fee: ��� �� <br /> Main: 952-249-4600 Fax: 952-249-4616 ww�N.ci.orono.mn.us p � <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be retumed. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 1 t(o S 'g(Z-o��J �A/4-�j ���t.d-I.� <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 w�th Police Department and City Council approval 60 days prior to the event. Shuttle bus service witl 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: �l� [�1 F�L�S��f <br /> State License# Expiration Date: <br /> Phone: Q S 2• � - OS'}9 (office) �ol 2• L'�o� �S�S (cetl) <br /> Mailing Address: .a. Ci :� ZIP: S'3'Z <br /> Contact Person: �.�� Applicant is: Contractor / om owner (Circle One) <br /> Email and/or Fax: V t l�-1 N�G tT 1 k�-a- C� Hfl1'Mr4 i�- . �-o� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �K► �� T <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �ol'b�( �ILt.lc-�!� <br /> Phone (day): (o�Z - �ZZ• OOG� <br /> Address: �l�t 2}y=` AV E.. S�. c�ty: M d LS ZIP: S�q (� <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 1 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 /> v�uvw.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � ������' ��� <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />