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.' <br /> ' � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions - <br /> Mailing Address: Permit number. 0��9 dQ <br /> O�,�,�.0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � i <br /> �`�. <br /> a � f-r� �, Street Address:' Received by: <br /> �.�, ? � Gtiti 2750 Kelley Parkway Plan review fee: � S�U, C1L) <br /> L�kESHOg'� Orono, MN 55356 P�a.r� R�v,� - �0 9_�o a� <br /> --- Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �, <br /> This application form must be completed in full and all required information mu be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: "Z,�33 �,Qs(,d QJNr (� <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 ill e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed. <br /> CONTRACTOR/AP�ICAN_T„�FO MATION: '�G <br /> Name: �U� <br /> State License# Expiration Date: �p <br /> Phone: jj office cell <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: (.G Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: E.Q � d�F�'1 G. <br /> PROPERTY OWNER INFORMATION': �' 1 <br /> Name: Wu-L <br /> Phone(day): . � y � <br /> Address: Cit : HV ZIP: <br /> Email and/or Fax V �� � $ G Gt� Q /U� <br /> ARCHITECT/ENGINEER I RMATIO� � b� � �.n �\ <br /> Name: G-��' <br /> Phone(day): <br /> Address: � CC� Cit : - ZIP: <br /> Email and/or Fax: �t�J� <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 ❑ Public Water <br /> �'Any earth m� � ammercial ❑Other(specify) <br /> MCWD review Uv bv �5���.� dustrial ❑ Private Well <br /> Minnehaha Creel �S rher:(SpeCify) <br /> 18202 Minnetonk �a � ���� <br /> Deephaven,MN ����� CS�� <br /> Phone: 952-471- � <br /> Fax: 952-471-06 <br /> �� 7 /.8�'9 - ��- . <br /> www.minnehahac ���� <br /> Estimated Coi ind) $ <br /> - 18- <br />