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, � � ,�� <br /> � <br /> Cit of Orono � � . '�� <br /> Y .�%<� <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: q <br /> ��T PO Box 66 Permit number: �D�13� �� �9 / <br /> � `VQ Crystal Bay, MN 55323-0066 Date received: //-�2, "�3 <br /> Street Address:� Received by: �6.5 <br /> yF ,� 2750 Kelley Parkway Plan review fee: � D�� 8 <br /> �c,` Orono, MN 55356 ao/3 -D// � <br /> !�'�ESHOQ' Main: 952-259-4600 Total Fee: <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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 2�� S ��s�� ����n-� ���Z <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: �jl'��-c,,.,��Z � ��-. � <br /> State License# '�'j C, 5�I'�#3 I -> Expiration Date: 3-3 i-��� <br /> Phone: (cell) 612- 2�►- 2��� (office) �SZ- ��I�- Ss�lo <br /> Mailing Address: ��fo� �1M z-.t,� R�J Z Cit : �S ZIP: SSti'tG <br /> Contact Person: S�<� (��,s��s� Applicant is: Contractor / Homeowner (CircleOne) <br /> Email and/or Fax: 5v{�J(-1j S-��c��.r�. cc� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �..rb -� a�;\ (�« ����J <br /> Phone (day): �1 S2- �?S- �1�`I6 <br /> Address: 2°��S ��-.sc�- c1��1� City: ��\� ZIP: 553-( � <br /> Email and/or Fax ,� o � �.�1 . c-0� <br /> ARCHITECT/ENGINEER INFOR�IIATION: <br /> Name: �l�ktr �K�tic_— <br /> Phone (day): ��-L-z�6- -75�� <br /> Address: � �, -t�n`� c ���C ��� �� Stias�t' Cit : .�� z��-. ZIP: <br /> Email and/or Fax: ,p<-+�-c� £SK���-�- . c�,.1 <br /> � <br /> PROJECT INFORMATION: Description of project: <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 �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) $ a...D.�I� <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />