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. . � ��,o <br /> ����� <br /> City of Orono � <br /> Building Permit Application � � ,�.� <br /> for New Structures or Additions `� <br /> Mailing Address: Permit number: G�� "' �44'�� <br /> /�,��� PO Box 66 <br /> /��..p� <br /> �\\ Crystal Bay, MN 55323-0066 Date received: <br /> =�1 1 <br /> r� I� • Received by: <br /> a � ��_j'� �.,, StreetAddress: <br /> �'�,s,t����� �ti�' 2750 Kelley ParkwaY Plan review fee: acZd.`�l <br /> 9kE3H�4'� Orono, MN 55356 <br /> �___- a7�<0 — ��a �� <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: ��_� 1�� C �� �,�-t-f�., ,�;� 1,>( • <br /> Will this be a Parade of Homes, Remodelers �howcase Home or other Display Home? ❑ Yes No <br /> If yes, a specia/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 I APPLICANT INFORMATION: <br /> Name: ��,�����i S 1��u �r`��ic.;r� <br /> State License# , ,�;� �y,c�e,Gj Expiration Date: ?� - 3 1 - ,���i 1 <br /> Phone: - � � - ��3 1 office � � - � � �; - c�i r'� cell <br /> Mailing Address: �5�� � ►�, �� -:, Cit : �'c m;y�c ZIP: � � � � <br /> Contact Person: „� Applicant is: ontract r / omeowner (Circle One) <br /> Email and/or Fax: ���,� � l� �i- �-13�-1 - �`�1s�51 <br /> PROPERTY OWNER INFORMATION: <br /> Name: ` �-��S ,_s �C_�{��VI.�' Cz �,� <br /> Phone (day): Sp i:� - ��I���- 03c� <br /> Address: City: ZIP: <br /> Email and/or Fax <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 & <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 (exduding land) $ ��!����7�-� , �� <br /> Last Updated: 9/29/2009 ' <br /> - 17- <br />