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� �I �����0 <br /> ' ;1�,1�'Q (�.-�'lj ��� G�i`�G - . <br /> f�ECEIVED ��� ��j� �=�� � ��Ul�tl �iVI.S S <br /> . � <br /> � � MAR 1 2 2010 City of Oron �� �� <br /> Building Permit Application <br /> c��nroFORorvo for New Structures or Additions <br /> � Mailing Address: ��G �,��� <br /> � \ Permit number: <br /> / 'Qv .�\ PO Box 66 � <br /> �Q t, Q��� Crystal Bay, MN 55323-0066 Date received: �/ f�' <br /> �,�,t �, <br /> II� ��s�z;;.. s.j� Street Address:' Received by: <br /> �����y,���� v���� 2750 Kelley Parkway <br /> 9g'��'� 4� � Orono, MN 55356 Plan review fee: <br /> ESHO <br /> Total Fee: �g��z <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us / ,J <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �.���� �Iv�� ��I �- r ; �' � � � <br /> �..�.� � - 7- a 3 -� a- � i <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes, a special event permit rs required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service ll be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events wil!not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: -�-�a�..�,�,� �fi��v �cc�j�iS��k.q <br /> State License# Z o 4 S�3 99 Expiration Date: 3—3�_ 20 �� <br /> Phone: 9S2- R5(o� �bll (office) 9 -237- 33�{b (cell) <br /> Mailing Address: y3 SS �eaatG �opd City� C�1/cq ZIP� �-,53�$ <br /> Contact Person: _j��Q„ �o�„ a,, Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: � QT�r„sa,,, �a,,.�,/,.,,,Q ��, <br /> PROPERTY OWNER INFORMATION: <br /> Name: �rec4.S;•le i1. �rp-,�a �1JOci��i`n�, <br /> Phone (day): ��z_ c{72- �y79 <br /> Address: yzis %•-�'//;4,., Loea �ast City�J.�/:.�.,afy;,r� ZIP� �536¢ <br /> Email and/or Fax DKL r4'� (� Fro.•�fi'erk�� ,�¢.-�- <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City� ZI P� <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 <br /> � Other: (specify) I ri� � OI•C�c�ce[� � Multiple Family/Condo ❑Warehouse ❑ Private Sewer <br /> ❑ Public ❑ Storage ❑ Public Water <br /> *"Any earth movement may require ❑ Commercial �Other(specify) <br /> MCWD review&permits. ❑ Industrial (�.-idq�2. ❑ Private Well <br /> � Minnehaha Creek Watershed District(MCWD) �Other. (specify) <br /> 18202 Minnetonka Blvd �..;dpG <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 o0°o <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />