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: - <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> �_— Mailing Address: Permit number: �O//–dQ /g <br /> �,�,�.� PO Box 66 <br /> O e:` O�, Crystal Bay, MN 55323-0066 Date received: .��� Gl <br /> � � � • Received by: � <br /> ��� <br /> ,� '�� ��,��� a�� Street Address: <br /> 's',�, ;', �i �ti%� 2750 Kelley Parkway Plan review fee: �/ , � <br /> t�Esx�/ Orono, MN 55356 ao�i-a � 7 <br /> �-___� Total Fee: 7 S <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us , .e "7 �� _ <br /> This application form must be completed in full and all required information must be submitted. �fi <br /> Incomplete applications will be returned. (Please print) s��- <br /> GENERAL INFORMATION: <br /> Job Site Address: s �'z.�E1� � ,E �4SS <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes, a specia/event permit is required with Po/ice Department and City Counci/approva160 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: �,y�.rZL� Cuo1� D� No�/o <br /> State License# ZOC. 3S Z4S Expiration Date: 3— .3) — Lp(3 <br /> Phone: Co 1 2— 3SS— j 70q (office) �/L — 490 — 7/¢Z, (cell) <br /> Mailing Address: ,$7�$'O 2 � A1fF• Cit : �ywjo ZIP: s' <br /> Contact Person: 5'T�VE l..��N-T Applicant is: Con rac / Homeowner (Circle One) <br /> Email and/or Fax: S L.��,N.(..T� C_t-(�.IL.I.-�SGc.�t�l� • L o M <br /> PROPERTY OWNER INFORMATION: <br /> Name: �4Jvp Y � I1'lA.ILI�!/E- p�F£7Z <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: �+ �.��,£5 Cutx'J l�EJti/ol/'O <br /> Phone (day): (Q/Z— 3S�— /70� <br /> Address: /SaSO 232� A-V� , /\/� City: ���//tijp�1T�f ZIP: SS l��7 <br /> Email and/or Fax: SUGthT C� Ct-h�1IZ.[.E'3�.unl� . Lo►"( • <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. ]ffi 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 $J Public Water <br /> '`'`Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review& permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Qther: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Pi�one: 952-471-0590 <br /> Fa>:: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ (�[�-�, OOC� � <br /> Last Updated: 4/26/2011 <br /> - 19- <br />