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� w <br /> � � . <br /> ��,c3 <br /> City of Orono � � <br /> Building Permit Application a 1 v�• � �D <br /> for New Structures or Additions � � <br /> Mailing Address: �3 - 3� <br /> ;%�,�,�.� PO Box 66 Permit number: <br /> !/O , O\� Crystal Bay, MN 55323-0066 Date received: ' � J <br /> �l x, �� � <br /> �I ' -.. I • Received b <br /> �,a i'�'t� � �,�,� Street Address: Y� <br /> \,�, ��, ��� �ti/ 2750 Kelley Parkway Plan review fee: �f(p�'2 y <br /> la���'t r�'����i Orono, MN 55356 ,��,�3_0O3 � <br /> k�sxo�`''i <br /> �--___= Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us E �• • <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: 3��''I c�hcr7� �1� <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 wil/be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitied events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �c(�c,rw��, (p��YU.L,`�'kY� Svl�. <br /> State License# �Cx.7 23 J6 Expiration Date: 3-31-2c�� <br /> Phone: 2- �3�- 7 office cell <br /> Mailing Address: ]Evl �Ns � . �,1�- Cit : �l,t i14 ZIP: �5)Zy <br /> Contact Person: S h � Applicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: rn�cc�h�,A�e�c�ra cci+�sfiru<:�tc�.cc�. <br /> PROPERTY OWNER INFORMATION: <br /> Name: F'c��, ��u��a+,�.� <br /> Phone (day): I U 3-��']�'r�- 735� <br /> Address: ��S�`{ Cli�,;ry�Gtu� City: c�Y:�n� ZIP: �J�SS� <br /> Email and/or Fax ��ay, e.�.�iuv�IG .,Mea�,co�w� <br /> �� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: S{ �yn�+�t �e=,,�'V� - �ert5lt '�} ���k <br /> Phone (day): 52-`13L-76(.� <br /> Address: 76U1 1�IS �(r- ��- City: j�p�(� J���ty ZIP: rJJ�IZ� <br /> Emailand/orFax: �er,cS«('� skp,v.�n,r�k ,��si�:� I)c..C"v�"� t�r: q5�-�i3 - i3�$ <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> ,�{� Water Supply <br /> �New Construction U 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 I'I 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: (SpeClfy) <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) $ ��3, 6� 2 <br />