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Oct 08 15 05:04p All Around 8004198422 p.1 <br /> . <br /> . <br /> , CITY (JF OR�NQ <br /> , BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES QR ADDITIONS <br /> �O A r Mailing Address� Permit number: �(j/5—p / �� �', <br /> �V� PO Sox 66 <br /> Crysial Bay, 14W 55323-0066 Date received: % D 4 <br /> Streef Address:' Received by: J-� <br /> 5- 1 2750 Kelley Parkway Pian review fee: /� �# <br /> `�t,� �,� Orono, MN 55350 <br /> �F S H d� / �D. <br /> Total Fee: (� <br /> iNain: 952-249�600 Fax: 952-249-4616 www,ci.o�ono.mn.us <br /> Th;s appEication `orm must be completed in full and al)required information must be submitted. ,�� `��a1�7 <br /> Incomplete applications will be returned. (P/ease print) �,y�qp <br /> GENERAL INFORMATfO(�: <br /> Job Site Address: �L�(� C4,�e��� ��,,,,,� � W��2�� Mf,J �S3al <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> !f yes,a specia!evenr per,mit is requircd�vith Police Department and City Councif approva!80 days prior�o the event. Shuifle bus service r��iN be <br /> required unfess applicanf demor,straE2s su(ficient onsrte parking is available. Non-permitted evenfs wiN nof Ge allowed. <br /> CONTRACTOR f APPLICANT INFORMATION: <br /> Name: � <br /> Stafe License# � ; E iration Date: � 31 <br /> Phone: cell _ j�t_ office <br /> Mailing Address: � � {y � i , '� � ZIP: 5 � <br /> Contact Persor�: �"�o,���� �{y,a Appiic t is: trac / meowner �cs«ieone� <br /> Email and/or Fdx: �- P• n ,", �- gyd <br /> PR�OPERTY OWN�R iNF�RMATION: `� <br /> Name: `�Ee_�h� a ���e.,. F+n�tt'4!�^ <br /> Phone (day): �la �3�E- Sy6S <br /> Address: lyl. (4,�5�. CG��usc [���� way�a(� � /''11.� SS"39( C�tY �n r�c.f� ZIP: SS�II <br /> Email and/or Fax 5��.Gn�y{r 2c„�,��,c�r.., <br /> ARCHITECT 1 ENGINEER EI�FORMATION: <br /> Name: <br /> Phone (aay); � <br /> Address: City: ZIP: <br /> Email and/or Fax: � <br /> PROJECT INFC?RMATI4N: Description of pro'ect� <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Dispasal& <br /> Water Supply , <br /> ❑ Netiv Construction [�Single Farnily with �Residence ' <br /> ❑Addiiion attached garage ❑ Garage 1Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Fa�nily with ❑ Deck <br /> ❑ Relocation �7 r7 detached garaye ❑ Office/Commercial ❑ Private Sewer <br /> � Other: (specify) r�ti-r�(x,� ❑ Multiple Family J Ccndo ! ❑ N�arehcuse <br /> I <br /> ❑ PubGc I ❑ Storage ❑ Public Water <br /> **Any earth movemenf may also require ❑Commercial I ❑ Other{specify) <br /> MCWD review E�permits. ❑ IndusCrial ❑ Private Well <br /> ti1innehaha Creek Watershed District(N1CWD) ❑Other. (speCify) <br /> 18242 Minnetorka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 ` <br /> www.m,n�ehanacreek.or <br /> Estimated Const�uction Valuation(excluding land) � `�j l•;� 0 . G� <br /> k � <br />