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R <br /> � <br /> 4 - � � <br /> ` ��� �� City of Orono <br /> Building Permit Application <br /> for New Structures or Additions � s��. 7 s" <br /> Mailing Address: Permit number: o�DD —DD /� <br /> �,0,�. PO Box 66 <br /> 0 :: � Crystal Bay, MN 55323-0066 Date received: r C'' [ � <br /> °� � <br /> Y� � <br /> p` Received b <br /> ,� ,. Street Address:� <br /> �,�,L � �����Gti 2750 Kelley Parkway Plan review fee: � � �• <br /> 9kESH�4 Orono, MN 55356 �(G�yL. �v�t� �.�rj9_���73 <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: dp n,,q p <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 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: C N�Rt.�-5 �upp C,o . <br /> State License# �oCo 3S2¢S Expiration Date: 3- 31 " ZC�lO <br /> Phone: Co/Z- 333 - �020 (office) (cell) <br /> Mailing Address: b �d , Cit : au7?-f ZIP: $�S <br /> Contact Person: ��-�(/� Lt GbfT Applicant is: Con r c o / Homeowner (Circle One) <br /> Email and/or Fax: �1� T� C A L.�'-S�C.!!� , o - Z- - ZO <br /> PROPERTY OWNER INFORMATION: <br /> Name: g�1sL� n,4ppOGl�C <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: K�lc��c.-r�/�7L � ,�{a�31 C!-Fal-u� <br /> Phone (day): �/Z- �3 S�- � �B�b <br /> Address: �/� S�o/ , 27S /ylA�Rk�`7^ `Jr City: /t'1�,�rr�i4PoclSZIP: SS4�S <br /> Email and/or Fax: �p,x �,)Z-- 3 3 a '- `�p0 S <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 � Garage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> �Other: (specify) �t`t�,op�-- ❑ Multiple Family/Condo ❑Warehouse <br /> �'X I SN�4 $c�A�T' �pc15G ❑ 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 �t Tsuj�'� <br /> Deephaven, MN 55391 ��5,T7�U <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 �p'(� �-�Oc-t5� <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � 2.2� (�pp, --� <br /> Last Updated: 6/22/2009 <br /> - 19 - <br />