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� , + � ,� <br /> J <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: <br /> g,�,�T PO Box 66 <br /> � Crystal Bay, MN 55323-0066 Date received: o�� D <br /> ii0 �,� � � <br /> ���'"' � Received by: Q <br /> I ,� �� - _ �, StreetAddress:' <br /> ��, ,��� Gti�' 2750 Kelley ParkwaY Plan review fee: <br /> '�9�E$HO�,'F' Orono, MN 55356 <br /> �— <br /> Total Fee: a�;s'Q <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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: , �p�� '`3�►-�,�„�`S � i,ti,�; 2�,F�� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [�No <br /> lf yes,a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be <br /> required un/ess applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ,4�lL,cc:C CLq-SS�c. GVENTS <br /> State License# Expiration Date: <br /> Phone: �SZ- -� 6309 (office) q57.. 922 -?23'3 (cell) <br /> Mailing Address: � � .3Sj'`'' Cit � .�vui a a� ZIP: b <br /> Contact Person: — S rr�'fi Applicant is: Contractor / Homeowner �c�►�ie ooe� <br /> Emailand/orFax: j'sn,;t-h (a1 aArceeclatsicevtn.ts. Co►� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �Att�� iYl. �-�,H�/i_,�l.r c✓v,��� <br /> Phone (day): �,�Z - g�j - 3Z�,(d <br /> Address: - , � Cit : ZIP: y <br /> Email and/or Fax m���•�� L�nv�n��v��� d��R.��«,r�� <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 8� <br /> Water 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) ���� ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage ❑ Public Water <br /> "Any earth movement may require ❑Commercial ❑ Other(specify) <br /> MCWD review 8�permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) �Qther: (speCify) .� r <br /> 18202 Minnetonka Blvd � E� ' <br /> Deephaven,MN 55391 ���,���v_ ,��% <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ , <br /> Last Updated: 6/22/2009 <br /> - 19- <br />