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` � <br /> C 1 t�/ Of 0�'O O �.� <br /> ' Building Permit �4 plication <br /> for New Structure� or Additions <br /> �0-�' MailiPOBo�r66. Permitnumber: �IUI1 - �`•�C�C.�.�j <br /> / � � Crystal Bay, MN 55323-0066 Date received: � -� � i � <br /> �( 0�� VV\ <br /> �I ,�; � � Received by: F_� ' ;� ;�1 <br /> 1,a � ' a,�, Street Address:' <br /> ���' ��'` � ` ti� 2750 Kelle Parkwa � � c� ,-�g l �� <br /> \t��Ix�,�,�/ Y Y ���t+�� Plan review fee: <br /> Orono, MN 5535f�C(� r � <br /> ,,�s�o � Fa �i.�� -;���.:>+-��-r �,�v�� �nL���_��� <br /> - _ _ � Oj i.'t�"Z � Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.oro o.mn.us , ; � <br /> This application form must be completed in full and all r uired information must be subrrttted < <br /> Incomplete applications will be retu ned. (Please print) :�� ' <br /> GENERAL INFORMATION: -�- <br /> Job Site Address: ' � S�/�� � �. <br /> ��'� .�� �- ��� . <br /> Will this be a Parade of Homes, Remodelers Showcase Home r other Display Home? ❑ Yes ❑ No <br /> /f yes, a specra/event permit is required with Po/ice Department and City Counci/appro al 60 days prror to the event. Shuttle bus service wi/!be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-per itted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: <br /> State License# � t Expiration Date: <br /> Phone: � office cell <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: Applic nt is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �;� - �':�r� T ��rr,��S�c� � <br /> Phone (day): = fs' � � - �/ <br /> Address: � S/ .�� 5 /�ri '-' .�i r i2�:��. Cit : �, « �, ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: �-/'- <br /> Phone (day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: I <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 �nvate Sewer <br /> �Other: (specify) 5C"`c'�'i'�� f"� �'c`f� ❑ Multiple Family/Condo Warehouse <br /> ������C- ,) c�GV f'X i y T��� ❑ Public Storage ❑ Public Water <br /> ""`Any earth movement may require ❑ Commercial Other(specify) <br /> MCWD review&permits. �C'�� ❑ Industrial � 'cr�� �G� N �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other. (specify) � X � S ���1 j <br /> 18202 Minnetonka Blvd C 6� � <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 �_- C' f: <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � O v �`' <br />