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�� <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: QD —�D8' � <br /> ��.� PO Box 66 <br /> � 0 Crystal Bay, MN 55323-0066 Date received: %`Q <br /> �a <br /> � �' �` ,� � StreetAddress:' Receivedby: <br /> `� Z�"'�� E� ? <br /> � ' '�0 �� 2750 Kelley Parkway Plan r i�e: � . �1 ''�� <br /> l9rt'� �� Orono, MN 55356 ` <br /> ESHo �DG 9- D��5 ,i <br /> Tofal ,� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us '�� " �� -� c,5 = �--' <br /> This application form must be completed in full and all required information must be submitted. <br /> Incompfete applications wilf be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 3 s�5 �,�.Se� `�op,��- �m,C,,� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes, a specral event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service wil/be <br /> required unless applicant demonstrates sufficient on-site parkrng is avai/able. Non-permitted events wil/not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Cl�l�-['Z-c...�S CuC�� �I �E l�o�'c� <br /> State License# _ ��� 3� z�5 Expiration Date: _3- 3 0- Zo►C� <br /> Phone: �8 2- 35'q— p�p�' (office) �6 z- �qo - � ��z (cell) <br /> Mailing Address: ��p�� �3 °t� o416E. �• City� pe���rjou�a f iy�ZIP s���� <br /> Contact Person: S7'E'�E �a c�T Applicant is: on racto / Homeowner (Circle One) <br /> Email and/or Fax: Sz r c�T(� �lze�scvn� �� �X - �(Z (oo¢ �ZD� <br /> PROPERTY OWNER INFORMATION: <br /> Name: [:�7�!'� -� �uE I��Cr-�E.� <br /> Phone (day): ' <br /> Address: _ Cit � ZIP� <br /> Email and/or Fax <br /> . _ ENGINEER INFORMATION: <br /> Name: _ l.�e�`�"�BCa <br /> Phone (day): 7�� _ Z,7? _ �B a� <br /> Address: yr�� �,-�S� ��v�rt �o��, Szr e� �Q$ City� /4?�iu,c(�jqpuGBs ZIP� �S�-�,j <br /> Email and/or Fax: �r��� �,,,R��d,�� ��.T�/4 _ �o/vt 7C0 � �7N— �P le � <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal& <br /> � New Construction Water Supply <br /> � 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 <br /> ❑ Other: (specify) ❑ Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑Warehouse <br /> ❑ Public ❑ Storage � Public Water <br /> ""Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review& 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 orq <br /> Estimated Construction Valuation (excluding land) $ ��� o ��; � <br /> Last Updated: 6/22/2009 <br /> - 19 - <br />