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1 k <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> O/�T PO Box 66 Permit number: �/��D/ <br /> � ` �'� Crystal Bay, MN 55323-0066 Date received: � - � /(�j <br /> StreetAddress:' Received by___ • <br /> 2750 Kelley Parkw # L.��� ,5� <br /> �F c? Orono, MN 55356 � ���������4 Plan review fee: � <br /> `qkESHO�� Main: 952-259-4600 TotalFee: `-� � 73 -`f � IL���, <br /> Fax: 952-249-4616 www.ci.orono.mn.us�cs�--av;, 1'C,�,.' 9- <br /> This application form must be completed in full and all required information must b�submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ="�' � -. " '�= � � r 3 L: <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes i�io <br /> If yes,a special 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 su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> � ,_ _� ; , <br /> Name: � ��� ! � 9 '� ��� 1���,c_�, ��� t , �i 1��_�C-fi L�;���� < <� i���., <br /> State License# ti.i -;��- �.� '> r�.�.� Expiration Date: <br /> Phone: (cell) ��_�<�, ��� ;",�_�� (office) ,�';s- � ,r�' -� -,-i -}� <br /> Mailing Address: '�;' �> - ,c �1t..: Cit - � ZIP. ;1~^,�, - >. <br /> • . , <br /> Contact Person: +;'Y}iC��C�i:t? "�Y�t Z Applicant is: Contractor / Homeowner �c�«ieo�e� <br /> Email and/or Fax: ��,���(�y, %'rY� <br /> ��-- <br /> 5� 8 / — —� c�3/ <br /> PROPERTY OWNER INFORMATION: <br /> Name: :'i;.<< `�_'<;��.�, <br /> �:. <br /> Phone (day): : ,�<_� , �� ��`�, ' <br /> Address: ��_ �,��,�" � , ;;� i�� t i���; City: ,' � , �;��.�:_ ZIP: <br /> Email and/or Fax �is�e•�}G�t � Q��( (.pw, _ <br /> J ) <br /> ARCHITECT/ENGINEER INFORMATION: �_���,,/��;�� f"��(C�� � <br /> Name: f G' _ <br /> Phone (day): ? <br /> Address: - � ; ...�2-��-' <br /> Email and/or Fax: ���� � <br /> �'" < <_ �(- , ,/ — <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3. j "' <br /> � �� ��% ���, � <br /> ❑ New Construction ��� �'Single Family with � % <br /> �Addition %�D ��� / attached garage ��'f. <br /> ❑Accessory B ilding � Single Family with [ � ,� "` -> • <br /> ❑ Relocation detached garage [ ,� � y�`�- " <br /> ❑ Other: (specify) ❑ Multiple Family/Condo [ <br /> ❑ Public [ _.__._ <br /> --� --_.... . .. <br /> *"Any earth movement may require ❑ Commercial [ t ,� �; 3 <br /> MCWD review&permits. ❑ Industrial _ ��' . <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952�71-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ��� � � ��J� - <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />