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� S U-`v�'�-�' <br /> � a Z �(-� � .r,,� . <br /> 0'./ <br /> � p°� Cit of Orono � <br /> �1 y <br /> ��i �"��'D� <br /> Buiiding Permit Application <br /> for New Structures or Additions �5��� - �aa��`'��3 <br /> Mailing Address: i �-�l � <br /> PO Box 66 Permit number: � , D�F� <br /> j�� , Crystal Bay, MN 55323-0066 Date received: <br /> �; � � � <br /> i1'� �� �' ' StreetAddress:' '' Received by: <br /> � � �_� �;-- 338, �3 <br /> \'�'� k�,j_ ti,i 2750 Kelley Parkway Plan review fee: <br /> ��l\� � , `����vG � Orono, MN 55356 <br /> \x�-H�4 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 appiications will be returned. (Please print) <br /> GENERAL INFORMATION: ,/� �'`�� 2 <br /> Job Site Address: � �1�� C���tV; z�.ca� �l11�� l.,/I��� ��'�1ti SS •:J S� <br /> Will this be a Parade of Homes; Remodelers Showcase Home or other Dispfay Home? ❑ Yes � No <br /> !f yes, a special event permit is required with Police Department and City Counci/approval 60 days prio�to the event. Shuttle bus service � be <br /> required unless applicant demonstrates sufficient on-site parkrng rs available. Non-permitted events will not be allowed. <br /> CONTRACTOR(APPLICAN INF¢R ATION: <br /> Name: �� 1-}- �()l�- i'�f <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �'C'�7� �UC ������z� <br /> Phone (day): /� � (� - 7 St/ � <br /> Address: �y 7 1��ti'��l�i.ti' c�� City: �y�;yt� ZIP: 5 SS S � <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: �r � �� <br /> Name: /�I7i�� f�n f� - �� � �C h> � � <br /> Phone (day): `� �;i - � St� �/�j S , ,t,�t . <br /> Address: S�1.z-/ �"�_i��� t c..✓ �,-� CitY� �I l/hH �r`t� ZIP: S S�G � <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project I 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply II <br /> ❑,New Construction ❑ Sing�e Family with ,�;Residence <br /> �Addition attached garage ❑ Garage/Accessory Bldg. �Public Sewer i <br /> ❑ Accessory Building i �Single Family with ❑ Deck <br /> � ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer ' <br /> ❑ Other: (specify) ❑ Multiple Family/Condo � ❑Warehouse ; <br /> ' ! ❑ Public ❑ Storage i ❑ Public Water i <br /> I "*Any earth movement may require � ❑ Commercial ❑ Other(specify) i �� <br /> MCWD review 8� permits. ❑ Industrial I �rivate Well I <br /> Minnehaha Creek Watershed District(M C W D) ❑ Ot her. (speCi f y) ' I <br /> 18202 Minnetonka Blvd II i � <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 � <br /> I Fax: 952-471-0682 I� � � <br /> www.minnehahacreek.or � <br /> Estimated Construction Valuation (excfuding land) $ <br /> Last Updated: 6/22l2009 <br /> - 19 - <br />