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� � ' J � 2� �3 <br /> , <br /> � City of Orono � 3�. 7� <br /> il in P rmit �4 lic tion �� �� <br /> Bu d g e . pp a . , <br /> for New�structures or Additions <br /> Mailing Address: . �� <br /> ��q, PO Box 66 ' t� Permit number: aDl�j-' � <br /> 1 VQ Crystal Bay, MN 55323-0066 Date received: �� " �� <br /> StreefAddress:' Received by: - <br /> 2750 Kelley Parkway '� Q�� $�' <br /> y � Plan review fee: . C� � <br /> F �c,� Orono, MN 55356 , _ d�� <br /> l�KESH�Q' Main: 952-259-4600 Total Fee:,, �d'�� <br /> Fax: 952-249-4616 www.ci.orono.mn.us -� ' V�C ' II�i' 'I,� <br /> This application form must be completed in full and all required information must be submi�t�d.', <br /> Incomplete applications will be ret�r d. (Plea print) <br /> GENERAL INFORMATION: �'-7`�'s C(q��� ��1 S� \n � <br /> Job Site Address: � �N ��� <br /> Will this be a Parade of Homes, Remodelers Showcase Ho e or other Display Home? ❑ Yes No <br /> If yes, a specral event permit rs 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: � (� ,D' I� JA� <br /> Name: �bv (,l� <br /> State License # L �-0 l Expiration ate:b ' ;-? ' _ <br /> Phone: cell office <br /> Mailing Address: �v Cit : � ZIP: <br /> Contact Person: � pplican�s: ontractor / Horneowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFO} ATION: , <br /> Name: Du� �d N � <br /> Phone (day): �� <br /> Address: l Cit : ZIP:,� � <br /> Email and/or Fax N � iti r <br /> ARCHITECT/ ENGINEER INFORMAT O � <br /> Name: d��l` C <br /> Phone (day): - � <br /> Address: Cit : 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 �.Single Family with ❑ Residence <br /> Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ O�ce/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 8� 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) � 1'�J���V�J � <br /> � �. <br /> Packet Last Updated. 04/19/2013 <br /> Page 22 of 23 <br />