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� � C'�lL� c� ���� -�?�a.� <br /> City of Orono � � �D <br /> c�� <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> �Q�O PO Box 66 Permit number: 3-�d /`,� <br /> Crystal Bay, MN 55323-0066 Date received: .5 `�-" �3 <br /> Street Address:� Received by: C.v <br /> -' 2750 Kelley Parkway � �'�O. z9 f� <br /> y .C` Plan review fee: <br /> �'� c,` Orono, MN 55356 �p/�3 -00 / <br /> �kFSHO�� Main: 952-259-4600 Total Fee: <br /> Fax: 952-249-4616 ���,;>; �� ����,� ,.,� 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: 0?,[�3S � Co�:ti ,d r:v� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <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 6e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION:� <br /> Name: <br /> State License# �(��.�6� s,3-�+ Expiration Date: ,3 <br /> Phone: (cell) �(�-761-��1,5' (office) <br /> Mailing Address: Cit : ' ZIP: g <br /> Contact Person: ��.,�,�-m���w.� Applicant is: ontrac / omeowner (Circle One) <br /> Email and/or Fax: �a[�,J��..�—{-e�. „� Q �,,�� � �',�,y�� <br /> PROPERTY OWNER INFORMATION� <br /> Name: ,P c�, p��;g,r <br /> Phone (day): G�a.- 30�- 333't <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMA/TION: <br /> Name: P�S .Qre�.=�� � <br /> Phone (daY)� 61��JC�- 9 <br /> Address: City:� `, ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction 0 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(sp ify) <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) � s �00 �`� <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />