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- City of Orono �„� ,5� <br /> . <br /> Buiiding Permit Application ��g <br /> for New Structures or Additions <br /> Mailing Address.� Permit number. � �U�� `CX.��� .,� <br /> �,L,0,� PO Box 66 <br /> ��, � <br /> Crystal Bay, MN 55323-0066 Date received: 7� /Z - �� <br /> ,� �' ' " �, StreetAddress:' Received by: �9..5 <br /> e,t> <br /> �'.�n "'� � 2750 Kelle Parkwa t� w � ! ���'^' <br /> o Y Y �xl- ��lo � _-. Plan re iew fee; S� �• S <br /> t�'kESHOg'� Orono, MN 55356 ����'��3� <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. (Please prrnt) <br /> GENERAL INFORMATION: <br /> Job Site Address: ( C eV ��Ot e- Y'. <br /> Will this be a Parade of Homes, Remodeler Showcase Home or other Display Horne? ❑ Yes No <br /> If yes, a specral event permit is required with Police Departmenf 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,i ' ;r� LL <br /> State License# ZD(o Z��S �vy Expiration Date: - <br /> Phone: - (,Q- office cell <br /> Mailing Address: {1 Cit : a � q�„n ZIP: <br /> Contact Person: „� i��,r Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATIO I- <br /> Name: �p�e,r ��vyla� rK� <br /> Phone (day): q�Z -e{75- 9'19�f <br /> Address: /y ( GGt�✓u CGcasc �r City:�Va►�O ZIP: SS �� <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION:� <br /> Name: �. (�xaK�! J �S%a v� �✓a u p <br /> Phone (day): `j5Z-V73- 87�7 <br /> Address: Qp( �, �a,� S,t- City: (itJay�.t�, ZIP: '.�s�q � <br /> Email and/or Fax: 952 _ �G�r7Z - �?ZZ <br /> A � <br /> PROJECT INFORMATION: �a r-1-1� D � n�v� l�p�c� i�-�,�r� <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 /> Last Updated: 4/26/2011 � <br /> - 19 - <br />