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' J City of Orono <br /> Building Permit Application <br /> for NQv�r Structures or Addit�ons <br /> Mailing Address: Permit number. ;.,��i o� -C���S � <br /> O�D,�.O PO Box 66 G <br /> � <br /> Crystal Bay, MN 55323-0066 Date received: D�� <br /> a f�� s, Street Address:' —�- ^� b � - <br /> �'L ' � ti�' 2750 Kelle Pa a � C� ��g `���a-�D I a a�o n�'r <br /> c� o Y Y Plan review fee: � <br /> '�E, SH�� Orono, MN 55356 <br /> Total Fee: <br /> Main: 952-24911600 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 retur►�ed. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: t 3� ��.j�� 1 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other splay Home? ❑ Yes ❑ No <br /> ff yes,a special event permit is requrred with Pofice Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless app(icant demonstrates su�cient on-site parking is available. Non-permitted events wrl!not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: /� <br /> Name: W i'l��'1"f" t� d' � N G CD <br /> State License# e. O� S_�_ Expiration Date: 3 f � D /� <br /> Phone: office ceU <br /> Mailing Address: O o n� Df!D Cit : p ; ZIP: ,s <br /> Contact Person: v /itJ,' G Applicant is: on rac o / Homeowner �c�►��eo�� <br /> Email andlor Fax: U e s� ; p <br /> P'ROPERTY OWNER INFORMATION: <br /> Name: E R i /•( /�/�4 FS t-A D <br /> Phone (day): �'S� — �J��3 <br /> Address: �,370 C H Q A R '`I f��1 C� Ci : � RDIVD ZIP: S S 3 �y <br /> Email and/or Fax qs� - q,3-7 - S/.S <br /> A,RCHITECT/ENGINEER INFORMATION: <br /> ►vame: 5 A L � 1�11tc�]i�'e��S} � l!/G <br /> Phone (day): /�S!- 3S/ —09�01 <br /> Address: QD� S occ7t-� FO�t 1�2fi'{t S 7-', c�tyc5,'11 r,fJ pTe R ziP:,S'SDBZ <br /> Email and/or Fax: �Sf -.3S/ -73�7 <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> New Construction Water Supply <br /> � ❑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 8�permits. ❑ Industrial �,Private Well <br /> Miinnehaha Creek Watershed District(MCWD) �Other. (SpeCify) <br /> 1f�202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952�71-0682 <br /> www.minnehahacreek.o <br /> Estimated Construction Valuation (excluding land) $ � � i?r L°t � �`. ��` G <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />