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Ci of Orono �� <br /> � � �`�' <br /> . Building Permit Application ' �� <br /> for New Structures or Additions <br /> , <br /> �-=-�_ Mailing Address: ' <br /> �D,j�. PO Box 66 Permit numbe�: �[/�—j�(y� <br /> 0 � � <br /> Crystal Bay, MN 55323-0066 Date received:l' ' �/ <br /> ��`� Received b <br /> ,� � +` �,/ Street Address:' y <br /> ��c, ��, �ti`� 2750 Kelley Parkway Plan review fee: 9 <br /> �EgH��/ Orono, MN 55356 <br /> �-___=� Total Fee: �..D ! ! .. <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us O�� <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: �'-(v� �-�� ��• � - <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$ervice will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be al/owed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: 1.fG�/ '�^r�� -}-�r.;ar✓7� <br /> State License# Zo�Z s Expiration Date: 3� r -�Z <br /> Phone: `�SZ "14�-- `�4�"� (office) ' (cell) <br /> Mailing Address: f�o i 2. .l-I r�,+-��/ � ____ City: �N��%�^�� ZIP: �� <br /> Contact Person: i.a /����c-.-� A,plicant i�: �ontractor / Homeowrler �ci►�iao�e> <br /> Email and/or Fax: b�+.r�,ol� :� I�.�,/ I�Y-os. co.-r, �yc�� I°1�2� �4�- 1 � <br /> � T <br /> PROPERTY OWNER INFORMATION: t�� <br /> Name: T'or�� f'--� r�nti'►�i�' {��� 1 '� .'+S�I�� <br /> Phone(day): i 1�..�;� ��c,—I 30 1 <br /> Address: 20 'r �JA �� Cit : - � ZIP: �52�� <br /> Email and/o Fax �� ��� — ���o <br /> ARCHITECT/ENGINEER INFORMATION: , <br /> Name: ��� ii�� �'.-,�..i �_-.�"-�iC:-�z--�"�- <br /> Phone(day): <br /> Address: City: ZIR: <br /> Email and/or Fax: <br /> , <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> �New Construction �'Single Family 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) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage �uqlic Water <br /> **Any earth movement may requfre ❑ Commercial ❑Other(specify) <br /> MCWD review 8�permits. ❑ Industrial ❑ Private Well <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.minneh cr ek.or <br /> Estimated Construction Valuation (excluding land) $ �17� � <br />