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CITY 4F ORONO �� <br /> BUILDING PERMfT APPLICATION I ��' <br /> FOR NEW STRUCTURES OR ADDiTION <br /> / �'� � Mailing Address: Permit number: �%�y" �" <br /> �,->�►�� �t � PO Box 66 <br /> ,� 0 `� \ \ Crystal Bay, MN 55323-0066 �ate received: 'I GI -N I�-J <br /> �I � <br /> ^ � ,� � StreetAddress:' "—' Received by: � <br /> -' � ��l 2750 Kelley Parkway �1�-�(Z� Plan review fee: 2-y ��'� C�v <br /> `� �� Orono, MN 55356 <br /> ~��'E���'R-`/ 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: `�/�p�� (�,ro���� P.YI�� � <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 Counci!approva160 days prior to the event. Shuttle bus service ill be <br /> required unless app/icant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/A�'PLICANT INFfJ MATION: <br /> Name: �,el�ra h ` C✓ <br /> State License# VD Expirati�n Date: <br /> Phone: cell )Z` ' ` 1p� 2 office — S�!l� <br /> Mailing Address: �sp t Y�✓� O� Cit : � d! , ZIP: <br /> Contact Person: Applicant is: ontrac r / Homeowner (Circle One) <br /> Email and/or Fax: � C,O1^✓� <br /> PROPERTY OWNER INFORI�IIATION: <br /> Name: ��I �' T 1 �-1�P�Yl11CA.✓`� <br /> Phone (day): �-- � <br /> Address: �� c rp� �v�Z, � City: �7J�v.1 a ZIP: J S'� <br /> �--� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: � LLf/ <br /> Phone (day): —(�� (p� � <br /> Address: i Cit : 1�il�h� ,�l1ti ZIP: ��� � <br /> Email and/or Fax: � � <br /> PROJECT INFORMATION: Description of pro ect: <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) �� • (,l;(��� ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> '"`Any earth movement may also require ❑ Commercial t er(specify) <br /> MCWD review&permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) �Oth r: (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 Construction Valuation (excluding land) $ f � ��b <br />