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� �� �-13 <br /> City of Orono <br /> Building Permit Application � � g,� 5� <br /> 7� <br /> for New Structures or Additions � <br /> _-__, Mailing Address: �� � � O <br /> �Q�O PO Box 66 Permit number: <br /> � Crystal Bay, MN 55323-0066 Date received: 5 a�'� <br /> � Street Address:� Received by: <br /> � � 2750 Kelley Parkway Plan review fee: ,� <br /> 'F c,` OrOnO, MN 55356 <br /> �'�kESHo4�' Main: 952-259-4600 Total Fee: � !3 r�� <br /> Fax: 952-249-4616 wvvw.ci.orano.i����.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: � �_�`���1�, �_�c,�c,�_ � �� �,u �- <br /> Will this be a Parade of Homes, Remodeler 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/APPLICANT INFORMATION: � <br /> Name: C h%�\ C�� ��� ���c�_ � ���� �_ c�v��� <br /> State License# �C r7_� 1� 3� Expiration Date: � I` <br /> Phone: cell office �t� �_ - ` ���— C� 1 <br /> Mailing Address: �3 OJ � c �-� � Cit : �{- , ��v�s kZIP: "-' ��- <br /> Contact Person: �r ��. �{-�,,�,v���vJ Ap.plicant is:��ontractor Homeowner (Circle One) <br /> Email and/or Fax: � � ���; � ��� c,Z C ;-� r�� � �1�'� i P S ,C� t�� <br /> PROPERTY OWNER INFORMATION: � <br /> Name: �e�� �- �,-,c�� r-c,� �� `<<1 ��S <br /> Phone (day): lr ��:—dO a— y�+ `�� <br /> Address: � Q 1�e�; ,h c� 1, v � ;-t Cit : �ti%o,� ? c.,�<.� ZIP: �S 3�1 <br /> Email and/or Fax � <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> N a me: 1��� � �����"`'� '� �.-,c:,� - �� ���� P C� S <br /> Phone (day): lp a—a , — ��S <br /> Address: a�3� �.��-'S� y "� r`— >� City: ��'1,��� ZIP: »�� I�'j <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <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 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) $ ��� � � � �3 <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />