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1 W <br /> �-�'� � <br /> � ,�/ � <br /> Cit of Orono �� <br /> Y <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: Q��(�� <br /> ��� PO Box 66 $> <br /> (/��' O\, Crystal Bay, MN 55323-0066 Date received: / Q <br /> � a �����>-��` s. � Street Address:� Received by: <br /> e::;-- <br /> �'�,n '' 'o�" ti� 2750 Kelle Parkwa <br /> � y Y Plan review fee: <br /> r�kESH04�' Orono, MN 55356 �j <br /> Total Fee. lP <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��S �7���� ' % f� � ���c ���.-� �� <br /> Will this be a Parade of Homes, Remodelers Sho ase 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: Gi�J��_' .�� f�f'�� l,'�i��;��4� ly � X/c� .J <����- • <br /> State License# a(;Sf�S�/`l� � Ex iration Date: � <br /> Phone: --� � p 3�- 3 l-�G/G� <br /> �(� - S�� -� "a office Gi� �r� - � ,- �= cell) <br /> Mailing Address: �� ,�«s-rl ��_,,,.,- � Cit : ������ r �� � . i ZIP: „` ���. <br /> Contact Person: � � � ��,�.-� Applicant is: _ on racf�= / Homeowner (Circle One) <br /> Email and/or Fax: � �; �;� �y;� �L p,<,�� �.�.�,� <br /> PROPERTY OWNER INFORMATION: <br /> Name: j�-,��f �,:�/, n �r�=f��� <br /> Phone (day): <br /> Address: �17.gS` L'� c< i tf y 5,��� U; � > Citv. �,��it �.' ZIP� S� .jS� <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 /> ❑ New Construction Water Supply <br /> �Single Family with ❑ Residence <br /> ❑ Addition attached garage ❑ Gara e/Accesso Bld <br /> ❑Accessory Building ❑ Single Family with Deck9 ry g' � Public Sewer <br /> ❑ Relocation detached garage �Office/Commercial ❑ Private Sewer <br /> ❑ Other. (specify) ��� i�r�;��`- ❑ 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) $ �"�S "' ' `" - <br /> � ����. <br /> -20 - <br />