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� $ � � 7�� <br /> �, <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> --_� Mailing Address: Permit number: �Q �� <br /> ������ Cr�ysBtal Bay, MN 55323-0066 Date received: � <br /> /0 �: ��, <br /> � "' �i� � Received by: <br /> � ,a f �' �,�, Street Address. <br /> ti�' 2750 Kelle Parkwa f 3 , 89 <br /> �� , �,. � Y Y Plan review fee: <br /> �9kESH�g'� Orono, MN 55356 � Q —Q Q-?� <br /> �_- Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 wwuv.ci orono rr�n.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: 1 Q�tj Cb Lo p/ �j� tsC�T <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 approva160 days prior to the event. Shuttle bus service will e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP ICANT INFORMATION: <br /> Name: 74/U�G.I�D .�.. Cr. <br /> State License# Qf / Expiration Date: <br /> Phone: 9 office /Z- Lz-�$�7QSf6 cell <br /> Mailing Address: T' Ly , Cit : ZIP: � <br /> Contact Person: oL p Applicant is: ontractor / Homeowner (CircleOne) <br /> Email and/or Fax: dAn S .Gom <br /> � <br /> PROPERTY OWNER INFORMATION: <br /> Name: K�fv�ru �u��x.l <br /> Phone (day): <br /> Address: ��$'$ CDu�fLDI� i City: �Q�ap z�P: ��391 <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ��L�C,k�Df3LQ �SIl��u ��P <br /> Phone (day): q� — '13-g'"177 <br /> Address: �{�/ �j.�.ST AfiC[S �Tl��%�T City: �Y�,l} ZIP: rj' J�'�`�� <br /> Email and/or Fax: qr�xRGcy('P�d►aI.Gam <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&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 /> Last Updated: 6/22/2009 <br /> - 19- <br />