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City of Orono <br /> Building Permit Application L��v �G( 5• 14• I.3 <br /> for New Structures or Additions <br /> Mailing Address: a0(�J _�� <br /> �0 A,O PO Box 66 Permit number: <br /> `� Crystal Bay, MN 55323-0066 Date received: 'Z�?-�-3 <br /> StreetAddress:' Received by: ��5--- _ <br /> —-- ` <br /> _� _— <br /> -� � 2750 Kelley Parkway ,.- � Plan review fee: �>, g� �Q <br /> �F c,` Orono, MN 55356 ` � <br /> __ ___ _ _ <br /> �'�kFSHo��" Main: 952-259-4600 Total Fee: ��3��� <br /> 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 /> JobSiteAddress: 2(077 G.AS<O �o�-�T �DA�4 <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 will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: J�.1/ ID Bt�1 e.DEP�S ►N C. <br /> State License# gL(,3 7 7C'Z Expiration Date: 3 -'3 I � ZOI�} <br /> Phone: cell �� . '7 n office IZ„- _ O <br /> Mailing Address: Cit : r.ltr,� ZIP: o� <br /> Contact Person: ��,.� � E��t,s��( . Applicant is: ontrac / Homeowner �c�r�ieo�e> <br /> Email and/or Fax: r�y� �4d 10 �V lWEitSMNt �U�l QSt- �1�r ��V'33 <br /> PROPERTY OWNER INFORMATION: <br /> Name: gILL � .�ut.a�£ SNxDE� <br /> Phone(day): tb7 . y 4� - b¢4 2 <br /> Address: 7 Po� R.d Cit : ZArT�1 ZIP: $�3C1� <br /> Email and/or Fax (�� s n y C,,,r- �o r•n� Ll�r�1 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�ect: <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. (�]t Public Sewer <br /> ❑Accessory Building [�Single Family with ❑ Deck <br /> ❑ Relocation s��` `bs�� detached garage ❑ OfficelCommercial ❑ Private Sewer <br /> ❑ Other: (specify) �- ❑ Multiple Family/Condo ❑Warehouse <br /> � HAI��S �FiCtAyr ❑ Public ❑ Storage � Public Water <br /> "`Any e rth movement may require ❑ 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.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � D O v OO <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br /> r <br />