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' .� � . <br /> City of Orono �5 <br /> Building Permit Application 1 � <br /> � � <br /> for New Structures or Additions 1 <br /> Mailing Address: <br /> ��A, PO Box 66 Permit number: q�0/ � �� 5 <br /> �V� Crystal Bay, MN 55323-0066 Date received: 6-3� <br /> Street Address:� Received by: 0� <br /> '� 2750 Kelley Parkway ��6�/,Qq <br /> y �' Plan review fee: <br /> F �` Orono, MN 55356 <br /> !�'�ESHo�� Main: 952-259-4600 �OL�,�lN� a�0/3-D// 2-- <br /> Total Fee: <br /> Fax: 952-249-4616 vr�:�^r r,i oron� mn us py� �' � <br /> This application form must be completed in full and all required information must be bmitted. va d �/►e�v�asa�„�,�'' <br /> Incomplete applications will be returned. (Please print) Q��d� <br /> GENERAL INFORMATION: /� <br /> Job Site Address: � � J (-Q, �D �/� <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 ll e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPUCANT INFO MATION: <br /> Name: � .-,-` 1–�0��r 5 � — <br /> 0 5�.� s.� �5 <br /> State License# j3 276"q�C;� I _ <br /> Phone: (cell) ,S"j2 :Z-� r��� (offic I �� _ <br /> Mailing Address: �, �,✓ / <br /> Contact Person: ' . o Applican � � 5 , — <br /> Email and/or Fax: o' ColSo, ' "ra�", � z .�fl--v� <br /> PROPERTY OWNER INFORMATION: I , � � <br /> Name: 1 <br /> Phone (day): � — � - <br /> Address: <br /> I <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INF(��'" <br /> Name: ���j � �� <br /> Phone (day): 1 „� � ��! G <br /> Address: �� "�W ) I � � <br /> Email ana � l � � � <br /> � � �l� � �( <br /> PROJECT � - � U � �� ,,-1 <br /> � - ���� � <br /> 1.Type of Prc � � 3. Str �`�/ <br /> �a �r� <br /> �ew Constr� \ r��,� Re Q <br /> u Addition V � D � ' ❑ G� n �, <br /> ❑Accessory Bui� ��� `�� , ❑ De 5 � � <br /> ❑ Relocation � � �,1�Y� ❑ Of <br /> ❑ Other: (specify) � Io" �W. <br /> ,n � � Sb <br /> *"Any earth moveme �/{ �U � J Ot <br /> MCWD review&pern� � �"� � <br /> Minnehaha Creek Watersl �� <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) $ �,�; �� <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />