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. - , <br /> ��, ��� ��� <br /> City of Orono <br /> � rr► cJ���',_"" <br /> Building Permit Application <br /> �or New Structures or Additions <br /> ���� MailiPO Boxr66. e$errnit number �Q� ! <br /> 1ri"; <br /> / O � O Crystal Bay, MN 55323-D066 Date received: :ll� � <br /> � ,� �i; �, Streei Address:' Recetved by� <br /> ��E, �� �.ti 2750 Kelley ParkwaY ; PJan review#ee �''""� ` <br /> \<dx�o�,�j Orono, PAN 55356 � ,�, a <br /> --��� ' TOtaI Fee: 2 �� � <br /> Main� 952-249�60� Fax: 952-249-�3fi16 www.ci.orono.mn.us � �� ��-� _.,,.�:� � <br /> This application form must be completed in full and all required information must be submitted. j y���f���(t.� ��c k bi� <br /> Incomplete applications will be returned. (Please prrnt) �� <br /> GENERAL INFORMATION: �h � � <br /> Job Site Address: 3 �S G t�.` cu a L K 1 E P�.�t j3S <br /> Wifl this be a Parade af Homes, Remode ers Showcase Nome or o her Display Home? ❑ es o <br /> Nyes,a specra!event permit rs required wrth POJice DepaRment and City Council approvat 60 days pnor to the event. Shuttle hus servi wiJt ke <br /> requlred unless appticant demonsfrafes sui�+cfent on-site parking is avaifable. Non-perrnrtted events will nof be allowed. <br /> CONTRACTOR 1 A LIC T INFORMATION: <br /> Name: f-�,.�or cr 4 La�a.�rt �a.�t�t ca <br /> State License# Expiration Date: <br /> Phone: !�3�- S - $3 cZ3 (o�Ce) 93"Z� q g�l�3 8�7 (cell) <br /> MailingAddcess: tS � : �wo u�. Cit : ( �IP: SS3 <br /> Contact Person: 1 4�. ( Applicant is: Contractor / H tc��iao�t <br /> Email andlor Fax: a, ta <br /> PROPERTY OWNER INFORMAT[ON: <br /> Name: rrr �- a. v. <br /> Phone(day): - <br /> Address: (�„� ac •�, Cit : j p ZIP: S-f.�S <br /> Email and/or Fax Q l t� v O. �e1�.- <br /> ARCHITECT!ENGINEER IN�ORMATION: <br /> Name: �p.�__ <br /> Phone(day): <br /> Address: City: ZiP: <br /> Email and/or Fax: <br /> PROJECT lNFORMATION: <br /> 1.Type of Project ( 2.Proposed Use _ 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑New Gonstruction ❑Single Family with ❑ Residence <br /> ❑Addition I attached garage Garage/Accessory 8kig. ❑Pub3ic Sewer <br /> ❑Accessory Building ❑ Single Family with �Deck <br /> ❑Relocation detached garage OfficelCommerciai `�P�ivate Sewer <br /> '�Other: (specify} �►�.�e.{t ? ❑ Multiple Famify!Condo ❑Warehouse <br /> '; ❑Public ❑Storage ❑Publi6Water <br /> ""`Any earth movement may reqaire ,; ❑Commercial ❑Other(specify} <br /> MCWD review&permits. ; ❑ Industrial �((Private Well <br /> Minnehaha Creek Watershed District(MCWD} Other. (s cify <br /> 78202 Minnetonka Bfvd I <br /> Deephaven,MN 55391 4 ra�.ce. <br /> Phone: 952-471-0594 <br /> Faz: 952-471-0682 <br /> www.m innehaha creek.o <br /> Estimated Construction Valuation(excluding land) $ �;'���"�..:�, ` � <br /> Last Updated: 9/29/20Q9 <br /> - 17- <br />