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, .� i� <br /> � � ,;� I , , �I)� <br /> : � <br /> City of Orono <br /> Building Permit Application � <br /> for New Structures or Additions �; � � 7 SS <br /> �� Mailing Address: Permit number: 9_ /3 <br /> � j_� � PO Box 66 <br /> /Q\,,} 0\, Crystal Bay, MN 55323-0066 Date received: 8"Z�D 9 <br /> � a ��'�m-��;; s. j Street Address:� Received by: <br /> �� "'�� ���� � 2750 Kelle Parkwa <br /> � y y Plan review fee: /��/3 , <br /> L9xE3H�g� Orono, MN 55356 aDQ -Q05/�. <br /> Total 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 submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �� �j�,���ZV�p�� D� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No <br /> If yes, a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: _��1_l..l��$�-�C-� '}�}�1�'1�5 , IJlIC.� <br /> State License# �fj��{rp3 3 Expiration Date: 3--3 � - I O <br /> Phone: 3 ,�1 -d� pp office �A�'1� cell <br /> Mailing Address: �3� NV��-} i �-FAL� iZD Cit :�'� ,O�E� ZIP: �53 7 <br /> Contact Person: Kl?R1" R b�i�J(.� Applicant is: / Homeowner (Circle One) <br /> Email and/or Fax: K�R�' �{�,f1�l�p��p(_.K�, ��� Q� (�r i�) [�C�S- �"b£33'.� <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Cit � ZIP� <br /> Ema�l and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <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 Disposal & <br /> Water Supply <br /> � New Construction �Single Family with ,�Residence <br /> Addition attached garage ❑ Gara e/Accesso Bld <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck9 ry g' � Public Sewer <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> ❑ Other: (specify) ❑ Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑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) $ <br /> -20 - <br />