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.. <br /> CITY C)F �RONO <br /> BtJILDING PERM�T APPLIC�ITION <br /> FOR N�W S�R�J�TEJR�� 4R I�DDi�IONS <br /> j' O^ , \ Mai/ing Address: Permit number LLI y - ,i ' <br /> � �"�� 'V� � PO Box 66 �:-1 <br /> i' '�, Crystal Bay, MN 55323-0066 Date received: i �! �Z `� ���� <br /> � ; � Received b �L--•� <br /> � Street Address ' /��'� � � Y -- � <br /> ��� ' � ���� 2750 Kelley Parkway � ���U.1y-� j;7,� :� Plan review fee� � � �.� .�� �,� <<L� <br /> �,y�E.sH���� / Orono, MN 55356 ---� I / <br /> --- � Total Fee: � l <br /> 1Main: 952-249-4600 Fax: 952-249-4616 ww�n�ci.oronc.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications wiil be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Jc�b Site Address: `'�pq� �,rn����,� ��Zi' c� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or��ther Display Home? ❑ Yes �No <br /> lf yes, a special event permit is required with Police Department and City Couna!approvai 60 days prior to the event Shuttle bus service ill be <br /> required unless applicant demonstrates sufficient on-site parking is available Non-permitted events will not be allowed <br /> CONTRACTOR/A PLICANT INFj� MATION: <br /> Name: ��y��� `' � � <br /> State License# uQ Expiration Date: <br /> Phone: cell 1'Z` � ` (0� Z office S—/Z,��' <br /> Mailing Address / �f►�✓� O:� Cit : � � , ZIP: „ � <br /> Contact Person: Applicant is: ontrac r / Homeowner (Circle One) <br /> Email and/or Fax: < , �,M,� <br /> PROPERTY OWNER INFORMATION: <br /> Name: '��?c?'�/ ` ^1-'Q1 1 �--i�E��Yl�'�6A,.✓� <br /> Phone (day): <br /> r <br /> Address: `�p �'�,r�+ ,,,,Z e Ciry: C"�j-a:�� ZIP: J�'�� � <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: y (,��, <br /> Phone (day): —�,j �j� , i <br /> Address: ) City: �`�i�;h�'��,�L..t."�. ZIP: �,�� ��S" <br /> Email andlor Fax: . , � ���+, <br /> PROJECT INFORMATION: Description of pro ect: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> New Construction ; Water Supply <br /> ❑ Single Family with ❑ Ftesidence <br /> ,��Addition g g ❑ Garage/Accessory Bldg. j ❑ Public Sewer <br /> attached ara e <br /> ❑ Accessory Building ❑ Single Family with ❑ C)eck i <br /> ❑ Relocation detached garage ❑ Office/Commercial � <br /> ❑ Other: (specify) ❑ Multi le Famil /Condo ❑ Private Sewer <br /> P y ❑Warehouse <br /> ❑ Public ❑ Storage I ❑ Public Water <br /> **Any earth movement may also require ❑ Commercial )t r(specify) I <br /> MCWD review&permits. ❑ Industrial �� ,r j ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) �Oth r (specify) � <br /> 18202 Minnetonka Blvd , li <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 I <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �C� C��U <br />