Laserfiche WebLink
. , o g� <br /> . , _ � ti�� �� << �-;� � �� � . <br /> � �? ��� ,cc�� City of Orono i� L 1 � �� ,°� ,3 <br /> c� -�� ��� �� � � <br /> �,� c��- .���� �;�� Building Permit Application <br /> for New Structures or Additions <br /> �O� MailiPO Bo�r66� �"�nit number: � /- � � <br /> Crystal Bay, MN 55323-0066 - uate received: <br /> F'J.S y'�.�',� O ,�µ'� Q <br /> ,a `�''�-'s�, s,) Street Address.�' �41� c �{�✓ � �,ceived by: ��� <br /> �' �� � '� ti 2750 Kelle Parkwa Z�J �y,� �' ��iC <br /> �L9g�� 4wG Orono, MN 55356 Y � � C'"" ��reviewfe�`,� `� � (V(:�A: ,� 7, e� <br /> ESH� '4�J �CI����J''� <br /> � Total Fee: <br /> Main: 952-249-4600 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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: eV ✓� , <br /> Will this be a Parade of Homes, Remodelers Sho case Home or other Display Home? ❑ Yes No <br /> If yes, a special event permit is required with Police Department and City Councrl approval 60 days prior to the event. Shuttle bus service ill be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: �aucr �u; ld;�, Lt � - <br /> State License# Expiration Date: <br /> Phone: L- (vlZ- $6 a- 569 office � _.�7 _Z5 (cell <br /> MailingAddress: L-(io2� S ,r, Cit : u l� (q;� ZIP: 35 <br /> Contact Person: � Q� '��6C<,� Applicant is: on ractor / Homeowner (CircleOne) <br /> Email and/or Fax: Z�3� y 79 _� �pZ� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �Do�e� �eW�.a r lL �.P�Z- " ��'Q -.�I'L� <br /> Phone (day): v r-j5Z - �-t-1 - n 77 7 <br /> Address � �{ ( �kQ�y C�,.,S� �v�, City: �YO►1p ziP: 553a � <br /> Email and/or Fax �����C�. ��j�s�� �;� <br /> ARCHITECT/ ENGIN ER INFORMATION: <br /> Name: (e xdr,�- c � „� �-o � <br /> Phone (day): 2 - - <br /> Address: �d 1 F � Lr,��� � S-i; City: (A��,,„���f o� ZIP: �5 3�1 � <br /> Email and/or Fax: <br /> �IC���- <br /> PROJECT INFORMATION: 1/ � � r - �l�1 � � <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction �$(Single Family with �Residence <br /> �Addition attached garage �Garage/Accessory Bldg. �J 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 /> 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) $ �' <br /> Last Updated: 4/26/2011 / � <br /> - 19 -�I ��2'--�LP� l�v0.S SP 1►-F- 1 �.. �YY�I� <br /> �p�c�...Lse �� ho�d �-� . G►'� <br /> .��s �r-};�r df �rmii- <br /> , <br /> � <br />