Laserfiche WebLink
� <br /> . ' <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �� -dd� � <br /> O�j,D,�.O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: Q <br /> ��<, Received by: <br /> � � ;�,�;r' �, StreetAddress:' , <br /> .�, Gti 2750 Kelley Parkway Plan r ' w fee: . 3 � <br /> ��kEsH�4� Orono, MN 55356 � �a��- <br /> — Total • , <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �� �� -�j � - L-' <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: .�lD5 Ca�� o►N`� �os�� <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: C E�afz.t.�s Cypo � �f No�e� <br /> State License# Zo co 3� z c�5 Expiration Date: 3- 3 f- Zo�c� <br /> Phone: �12- 3Srl- l7oq (office) CoDZ- �qp - 'a j¢Z (cell) <br /> Mailing Address: �5�o S� Z3 �� �4VE. .'�0• City: p�y�jvu�1 �y�ZIP: SS�¢� <br /> Contact Person: S`TEvE Lr c�LT Applicant is: on rac o / Homeowner (Circle One) <br /> Email and/or Fax: 5��cuT� c�Ftc..�scvv� . �.oM �X = lv(Z- (oo�- /Zo� <br /> PROPERTY OWNER INFORMATION: <br /> Name: @C�NT � �uE 6��c�-(�E'`f <br /> Phone (day): � <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> . . �NGINEER INFORMATION: <br /> Name: L.��T�ll� <br /> Phone (day): 7Co� - 277 � m4 CI 8 <br /> Address: .SZo o �ST R�v�rl �vfa-D , $u iT� ��$ City: Mv+�,cldq�vG05 ZIP: SS�¢-2..� <br /> Email and/or Fax: ���, /y,�,�so�O �Bt.TE/4 . C_�/�'� 7Co 3 - 571- 9/l0 8 <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <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 $J 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.or <br /> Estimated Construction Valuation (excluding land) $ ��,� , p�,-.--s <br /> Last Updated: 6/22/2009 <br /> - 19 - <br />