2009-00168 (adv. plan review) - Laserfiche WebLink

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City of Orono Building Permit Application for New Structures or Additions . .--� Mailing Address: Permit number: 6 —��/ ��,�.� PO Box 66 p ` Crystal Bay, MN 55323-0066 Date received: J� .3 � / � ja,y � � �� Received by: .� `�,�,'K's � �,a�� y, ; Street Address:' '5��, � ir`" �ti/ 2750 Kelley Parkway Plan review fee: j (�� - � ( �/(o .� �kE�_H�� Orono, MN 55356 Total Fee: Main: 952-249-4600 Fax: 952-249-4616 v�nvw ci orono.mn us This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: 31 Z"1 A ��, ��"� `�2r•.Z- Will this be a Parade of Homes, Remodelers howcase Home or other Display Home? ❑ Yes � No If yes, a special event permit is required with Po/ice Department and City Council approva160 days prior to the event. Shuttle bus service wil/be required unless app/icant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be al/owed. CONTRACTOR/APPLICANT INFORMATION: Name: ��h��r L ��- State License# �c��43 i5' Expiration Date: 3 - '3 d- ��y Phone: �5'Z- ��('1 - SS90 (office) d��2- 2c�� - �c>��r (cell) Mailing Address: 7Na'f w�yzkfh �I�Z City: ,��nnt-.p41,, ZIP: s 5�(zb Contact Person: S�tN C��kSfihFS�N Applicant is: Contractor / Homeowner (CircleOne) Email and/or Fax: y��r-� � S-1b*�•,��-oZ. `r�� PROPERTY OWNER INFORMATION: Name: �rc L Q<kcc5 Phone (day): ��1 z-- '32�-;bO u� Address: 3t�-'1 Cu;-u a�a�:-r SZn� Z City: c,�t�.��rr c ZIP: Email and/or Fax ARCHITECT/ ENGINEER INFORMATION: Name: �---�- . A1{ ZJ � ��EF�/ ��„�nus`''�< Phone (day): ry52- y73-'$��►`t � 320- 2.5'1 ' v5'1S Address: 3�0 }-{wy Io S� s�t �� City: 5f.C(�.. i ZIP: 5�3oy Email and/or Fax: SA.L 2�c 0 d.,FY,- NK. �o� PROJECT INFORMATION: 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& Water Supply �New Construction �.Single Family with �Residence ❑Addition attached garage Garage/Accessory Bldg. � Public Sewer ❑Accessory Building ❑ Single Family with ❑ Deck ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer (�Other (specify) ��tn1�5 Co�t"� ❑ Multiple Family/Condo ❑Warehouse ❑ Public ❑ Storage �Public Water ""'Any earth movement may require ❑Commercial � Other(specify) MCWD review&permits. ❑ Industrial "f��c,a�� Ls�J'� ❑ Private Well Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) 18202 Minnetonka Blvd Deephaven,MN 55391 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or Estimated Construction Valuation (excluding land) $ �0 Q .n �o � � - 18-