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` City of Orono �„� ,5� <br /> , <br /> Building Permit Application �f� <br /> for New Structures or Additions <br /> Mailing Address: . �`f_��j�2 <br /> O�,�,�.0 PO Box 66 Permit number: <br /> � Crystal Bay, MN 55323-0066 Date received: 7" �2 — �� <br /> � <br /> ,a ���''�. ,.l StreetAddress:' Received by: ,�C/.� <br /> �'.�,L� �� A� �ti 2750 Kelley Parkway � (c��� �j� Plan re 'ew fee: .��s '�• = ` ' <br /> �kESHOg'� Orono, MN 55356 <br /> - otal 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 sub � . <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ( C e�/ C�IOt � �r'. <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 be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP ICANT INF RMATION: <br /> Name: e ' �r� LL <br /> State License# ZD(o Z�.S Coy Expiration Date: - <br /> Phone: — (,Q- office cell <br /> Mailing Address: {.� Cit : a � �,n ZIP: <br /> Contact Person: � ,,< <��,r Applicant is: ontractor / Homeowner (CircleOne) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION,;,� <br /> Name: �0.�1e,✓ Ke-w�ac r� <br /> Phone (day): C��Z -�75_ q I9�{ <br /> Address: _�y ( G�t�✓u C ltasc �r City: �✓�Ko ZIP: Ssg� <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: c xct ��. cs:c► ►n ►ra u p <br /> Phone (day): 5L—Y73— 8777 <br /> Address: 4p( �� �a,� S'.t-, City: (il�ay�.�, ZIP: �53� � <br /> Email and/or Fax: 95Z _ lyc7� _ �zZz <br /> � <br /> PROJECT INFORMATION: �ar-l-� D � r�:� 1��c,� ,�'�'��v� <br /> 1.Type of Project 2. Proposed Use 3. tructure 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 ❑ 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) $ '7� .�� , <br /> --� � <br /> Last Updated: 4/26/2011 <br /> - 19 - <br />� <br />