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S <br /> fy� . <br /> Ci of Orono � . '��;��'�`� ` <br /> � .� � �� <br /> Building Permit Application ���� ..� <br /> for New Structures or Additions �'�� <br /> Mailing Address: Permit number: �QQ —���� <br /> O.g,o,�.O Po Box ss <br /> � <br /> Crystal Bay, MN 55323-0066 Date received: � � <br /> � '-;;�, ,. StreetAddress:' Received by: <br /> 'S',�, � �ti 2750 Kelley Parkway Plan r iew fee: � S � <br /> �kESH�¢� Orono, MN 55356 Total �G�i��9��) <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: /�S ec�e('w oo� � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> !f yes,a special event permit is required with Police Department and City Council approval 60 days prior to the eve�rt. ShutNe bus service "ll be <br /> 2quiied unless applicant demonshates s�cient on-site parking is available. Non permitted events wil!not be albwed. <br /> CONTRACTOR/APPLICANT INFORMATIO : <br /> Name: o„` �i�...; C ;o.� �L <br /> State License# �vy9o��o-y Expiration Date: 3 � o <br /> Phone: /a-- i - 7 office .�,-..� cell <br /> Mailing Address: y�a� 3�� � �) Cit : ,,.... � ZIP: S y <br /> Contact Person: .,,� ;,,r. ;� Applicant is: ntra / Homeowner (Circle One) <br /> Email and/or Fax: '� c. � +.�-.s c,9� 7�3� ��S-�8 6 Q <br /> PROPERTY OWNER INFORMATIQN: <br /> Name: o,�s,c d-(✓wvC Sa r� <br /> Phone(day): ��95a-a-S� -v b9 <br /> Address: /PS �de�r-m�/ �r City:�r�a ZIP: �S"3S� <br /> Email andlor Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: 0✓�fJ- <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal8 <br /> Watier 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) �e�-✓fe'^� ❑ Multiple Family/Condo ❑Warehouse f i��,� <br /> ❑ Public ❑ Storage ❑ Public Water ;\ �a <br /> "Any earth movement may require ❑Commercial ❑ Other(specify) ' <br /> MCWD review&permits. ❑ Industnal ❑ Pnvate Well �� � <br /> ,` :� <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.m innehahacreek.o <br /> Estimated Construction Valuation (excluding land) $ ,�SL D_o0 <br /> Last Updatetl: 9/29/2009 <br /> - 17- <br />