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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: I Permit number: <br /> /g,0,�. PO Box 66 <br /> , Q O\ Crystal Bay, MN 55323-0066 Date received: <br /> � � �� <br /> � I� Received by: <br /> ';,� �' m c;;� �,� Street Address:' <br /> '�.�, '�"� �ti�'� 2750 Kelfey Parkway Plan review fee: <br /> L�kESH�4�/ Orono, MN 55356 <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: y0(vo �R�«-L� �-A , ��J�Q � �!� �s�� y <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 Counci/approva/60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking rs available. Non-permitted events will not be alfowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: SqM ES �� N�✓F� <br /> State License# Expiration Date: <br /> Phone: 9Sd-S y/ �/�3 9 �xY 1o�office) QSa - �E7��3G'78 ko►••a. cell) <br /> Mailing Address: d Go aA�I{-� � Cit : /�'t�ov�v0 IP: .t 3s� � <br /> Contact Person: S Nt,E S o(� Sq-c.K�E /V'E dE Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: ��,,.�v�,Q�e � a�a�a. �a�►�c 6��ckie tnc.ve. P nvadl.4 • c,o•-n <br /> PROPERTY OWNER INFORMATION: <br /> Name: .�M�t f�,s �, 1\f P✓E �i4-�-1<< E M• I�EdE <br /> Phone (day): 95�� Sy/-!�9 9 ex�' to-z- -k`f' �� � <br /> Address: ,p Cit : M ov Nd ZIP: S�'3� <br /> Email and/or Fax ��,K,,n,p�.r� �+ ac✓a m_ c�a .Y. aa�r�nev.e (� casa e. . �ow� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: G <br /> Phone (day): <br /> Address: City: ZIP: <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 ❑ Private Sewer <br /> (� Other: (specify) �}Y�A�K mc.s �"�IFE,� ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public � Storage � ❑ Public Water <br /> *'`Any earth movement may require ❑ Commercial ❑ Other(specify) � <br /> MCWD review&permits. ❑ Industrial ❑ Private WeIF <br /> Minnehaha Creek Watershed District(MCWD) , � Other: (specify) �/o� �y��G�l,1 <br /> 18202 Minnetonka Blvd �e�sse, r <br /> Deephaven. MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � Z. �ea� o �-x�J -� <br /> �"O �r c✓1�. <br /> Last Updated: 6/22/2009 a��� -� � f 'L k � <br /> - 19 - C�rty o_�/� Oronm kas c��� <br /> QreM�t�aL a� �/ct��el�tc-� �01� <br /> v.`,ti� t��'f'� t'� rs (ecq,'E� <br /> o`^. `r-{�.C. P f`op�f`�-y <br />