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. q���� � <br /> � <br /> � <br /> u. <br /> City of Orono <br /> Building Permit Application � <br /> for New Structures or Additions � 13o�-?S <br /> — Mailing Address: Q D <br /> �/��,1`j� PO Box 66 Permit number: d O/d �' g�� <br /> Q , QA\ Crystal Bay, MN 55323-0066 � Date received: 9 2,1 ( <br /> �� �. I� <br /> ��a '�'�r��r�," �.;; StreetAddress:' Received by: <br /> �'.� ����' ��,�, G�� 2750 Kelley Parkway Plan review fee: a?O/D "�0873 <br /> ��gE��og,�ji Orono, MN 55356 � � <br /> �- 8a3-8'9 <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: 2 Z��i7 /ah;�c,,�:� ;-. ��;c�,� Or-��1c; 1�1}J �53.�� <br /> Will this be a Parade of Homes, Remodelers howcase Home or other Display Home? ❑ Yes �.�No <br /> /f 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: <br /> Name: `3�-o v�z�;;=c�u r.� Li.C.. <br /> State License# Z v��iy"3 I 1 Expiration Date: 3 / 3 ��Z v�Z <br /> Phone: ��SZ� (v"I? - ��`1 C> (office) l�12� 2 2.I '�� (cell) <br /> Mailing Address: � � � Cit : ZIP: �'-",r'�-�Z <br /> Contact Person: ���� �hlc �w�.u.,�. Applicant is: ontra / Homeowner (CirdeOne) <br /> Email and/or Fax: j..�,�Gn Sk`,�r_v..%nc..:�. Cuv� <br /> PROPERTY OWNER INFORMATtON: <br /> Name: �v��v� Y�lu��le►� <br /> Phone (day): ' �'Z, 2 c ZZ <br /> Address: 2 .� Cit : (� - 1 ZIP: '; <br /> Email and/or Fax -j-�,,i�,l�z�� � �� L�'��,,,.` <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <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 8 <br /> ❑ New Construction Water Supply <br /> ,�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) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> *'Any earth movement may require ❑Commercial ❑ Other(specify) <br /> MCWD review 8�permits. ❑ Industrial 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) $ �'�(�, �)��. ��; <br /> Last Updated: 9/29/2009 <br /> - 17- <br />