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.' . . • ��� 7�'S� --�- <br /> City of Orono �� ���, �.� <br /> Building Permit Application � <br /> for New Structures or Additio s -- <br /> Mailing Address: I� 02- pGb C.� <br /> �,0,\�. PO Box 66 Permit number: � <br /> O k\ O Crystal Bay, MN 55323-0066 Date r ceived: �o�-��--- <br /> '.�„-;_ <br /> a -� j s, Street Address:� Recei ed by: <br /> '�, �� ������� �ti`� 2750 Kelley Parkway Plan review fee: � .j�9 <br /> t9kE3H��'� Orono, MN 55356 a0/a-ODO�vS <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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 3l� (�prc� C��[.�-c dliho /hy✓• S�3a 1 __ <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> If yes,a specia/event permit is required with Police Department and Ciry Council approval 60 days prior to the event. Shuttle bus service �ll be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events wil!not be allowed. <br /> CONTRACTOR/APPIICANT INFORMATION: s• ''�' ��S "� "'� 1 r UG�� � t'C <br /> Name: --�' - - - <br /> State License# �3�5 Expiration Date: �� g <br /> Phone: office cell <br /> Mailing Address: P�+'!�'t0 Cit : (,v ZIP: 5 <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATI N: <br /> Name: �{.r,na� � �I/r4��►�i,� /� �//a'NT� (Z� �-��,G�19t�c1 <br /> Phone(day): �t-+(IV-3�D� �/1'�19-1 zSs-� <br /> Address: �p�j G,,a.s�a C�,•r�s � City: D;,�,.�d ZIP: S'�3 �1/ <br /> Email and/or Fax T�,; �1 Lm�c� Cv n�,.•�c , c.orn 1�1 i„�.a�,11�,. ��e � c.e,�, <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: /��1� S��r��� <br /> Phone(day): t{,SZ- �{�p - �i l S 0 <br /> Address: � ,- S . Sc,'�-� /U o Cit : � 1 � ZIP: '�' > <br /> Email and/or Fax: 'h(�(A�( S �, �i a'rt"a1c.s�G� . r�,,, <br /> PROJECT INFORMATION: <br />� 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction �Single Famify 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) ►�CstD .L� ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑ Private Welf <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 /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ -�S-�L � ��1��`J <br /> 'E.���"-Tj(�-�� � �-1-�11�1C—,,� f�1�1�"� <br /> Packet Last Updated: 10-20-2011 <br /> -20- <br />