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City of Orono � � �(� � <br /> D � <br /> Building Permit A lication �� <br /> pp <br /> for New Structures or Additions <br /> Mailing Address: Permit number: — dD <br /> �.,0,�. PO Box 66 <br /> Q , � Crystal Bay, MN 55323-0066 Date received: r7�-�j7/� <br /> ��� <br /> �� � -� F � Street Address' Received by: <br /> ����� � l R 9 3.39 <br /> r9��'r��rv°~ Oro�no MNy Parkway Plan review fee: <br /> kEsxo�'' , 55356 p?p /a _ 0 09 lP3 <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: �U L,z.`L;` �`,��,� ��s' <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 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: � / I <br /> Name: rne��e V%c�eo ��✓��.5�, n �+c . <br /> State License# C S� Expiration Da : 3- 3/-Za I 4 <br /> Phone: S2� y - 3 /Z (office) (cell) <br /> Mailing Address: �,s,re oa,q( Cit : G kt ZIP: !dl•u S53/� <br /> Contact Person: 1�cah Sotinso.., Applicant is: ontracto / Homeowner (CircleOne) <br /> Email and/or Fax: �Tot,,,f,,, Q �,,,,,�-t,•,,.,� . ��,�, <br /> PROPERTY OWNER INFORMATION: l� � r`^� <br /> Name: �r�e-f+�e `�'1Q�1' tU - �o��-7 ��"����7 <br /> Phone (day): 952-237- 3�Vo <br /> Address: y3 SS �lavtti �ZeQ.1 Cit : C�t�s�cq /!�� ZIP: S S�3/ �' <br /> Email and/or Fax DTeb•,.ros Q �-fo-.�..�+�e• co.+-. <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Ske�rr.+f �al%q►. <br /> Phone(day): �'jSL-y'70-�f '7Sa <br /> Address: yby 2'.� S'/, ,SK;�e. /OI Cit : E,r�elt;or /hN ZIP: SS,33 / <br /> Email and/or Fax: ;,,.{� (� ,S'k 4rY4/7F��J!9�• �01s7 <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 ❑ O�ce/Commercial <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse � Private Sewer <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "`"Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review 8�permits. ❑ Industrial <br /> ❑ 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) $ 7 3 5,D� <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />