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,��,��_,��� Q I��2� <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: <br /> ��,0,�.�� PO Box 66 <br /> �� Q�� Crystal Bay, MN 55323-0066 Date received: <br /> ��� ��I Received b <br /> ��a '�t,' a!� Street Address_' Y� <br /> !V ��_ - <br /> �',�,� �,��1��,,,'�;„ �ti� 2750 Kelley Parkway Plan review fee: <br /> ti�����`��/ Orono, MN 55356 <br /> `�kEsxo�`' <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: �a� l �a,,�,� ��� ���.(� <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: �r'���.1+� E�c�-�,r-�orS , J,rn�- <br /> State License# ae�a9aa 7 Expiration Date: 3- 31 " aol a <br /> Phone: �4'� -qap-qs�yp (office) (cell) <br /> Mailing Address: �{�,0�-1 P G( Cit : ��,a; 6,rk ZIP: �$"�/l L <br /> Contact Person: ��{-� Applicant is: ontrac r / Homeowner (Circle One) <br /> Email and/or Fax: Q�a-q;tp=q b l 1 <br /> PROPERTY OWNER INFORMATION: <br /> Name: �.rlwa.` ��e.�v� <br /> Phone (day): G(a-�{83-8`(7q �`�t'��O'` <br /> Address: 1a`I� 3�ew�+ �oac) Sc��-�^ City�.,p�ewt�r..�' ZIP� �'S 3q ( <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> �,._,/ Water Supply <br /> ❑ New Construction ❑Single Family with �Residence <br /> ❑Addition attached garage ❑ Garage/Accessory B�dg. ❑ Public Sewer <br /> ❑Accessory Building (�Single Family with ❑ Deck <br /> ❑ elocation , detached garage ❑ Office/Commercial ❑ Private Sewer <br /> Other: (specify) �Cpa., � ❑ 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 /> wwtiv.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ g��Q(�. OO <br />