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• ci�r oF o�oNo � <br /> BUILDING PERMIT APPLICATION � 7��" �0� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Ma!lingAddress: permitnumber. �Q/" — Z`�J <br /> � NO PO Box 86 <br /> Crystal Bay, MN 55323-0066 Date received: �Z '�3 <br /> StrsetAddress:' � Received by: _____ <br /> y� `�' 2750 Kelisy Parkway /A�/i�(`` Plan review#ee: 0?0/3- G�O 77�Z <br /> ��kESi-304�G Orono, MN 55356 �'`+V 8 b'l,� Qds �j/ ?• lp � <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-248-4618 www.ci.orono.mn.us <br /> 7his application form must be complsted in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � �4 �t '7 C� 5 LlJ G�R �L E Q�O/�� /yI/� 5S?`?/� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes,a specral event permlt rs rsqulred with Police Departmenf and Cify Councrl approva160 deys prfor to the event. ShutHe bus service wil!be <br /> required unless applicanf demonstrates su�cienf on-site perfcing Is ave!!able. Non-pemtftted events will not be allowed. <br /> CONTRACTOR!APPLICANT INFORMA710N: <br /> Name: S%U IVE. Il�,/(�LjD LL(�- <br /> State License# �,�s��/5 Expiration Date: <br /> Phone; cell � office <br /> Mailing Address: � �jo f��2�1���_ L(/,D City. LS ZIP: 5"53 9% <br /> Contact Person: Appficant is: Contractor / Homeowner �c��aa o�a> <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �DE ����(>C.�f2/<E � /-!,e/S c7 �RO(�ZKE <br /> Phone(day): �'� ! —�J7 U <br /> Address: ' �� ;t '7 Ct�S�� G�/�GL� city:UiC'UN_'> `�l/t/ Z1P: _S5 3 9/ <br /> Email and/or Fax <br /> ARCHITECT!ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Emaif and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro'ect: <br /> 1.Type of Project 2, Proposed Use 3.Structure Type 4.Sewage Disposal 8 <br /> Water Supply <br /> f�ew Construction ��Single Family with Residence <br /> ❑Addition athached garage ��Garage/Accessory Bidg. �Public Sewer <br /> ❑Accessory Bullding �Single Family with Deck <br /> ❑ Refocation detached garage � Office/CommerciaE ❑ Private Sewer <br /> ❑Other: (speafy) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage "�Public Water <br /> **My earth movement may also requfre ❑ Commercial ❑Other(specify) <br /> MCWD review&permlts. ❑ fndustrial ❑Private Well <br /> Minnehaha Creek Watershed District(MCWD) ,�Other. (spe,Cify} <br /> 38202MinnetonkaBhrd •j�q�t �-o�-x� <br /> Daephaven,N1N 55391 <br /> Phone: 952-471-D590 <br /> Fax: 952-471-0682 <br /> Estimated Construction Valuation (excluding land) $ � �� �G'� , l��� � £-''�- <br />