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City of Oron�`��i��/ � �3�, a5 <br /> ' � Buildin Permit Application � :__v_. <br /> 9 <br /> for New Structures or Additions <br /> Mailing Address: � Permit number. o?Dl�—� �7�� <br /> � g'� C�sBtal Bay, MN 55323-0066 I Date received: '" z �� <br /> � ���r� � <br /> � Received by: J�S <br /> !I Street Address:� ��6.3� <br /> �, ,��,�� �,�'� ;;�`' ti� 2 7 5 0 K e l l e y P a r k w a y P l a n reviewfee: �/ <br /> �``'l�'�����r�� Orono, MN 55356 ao/l 0 0 77G <br /> ESK� Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us I <br /> This application form must be completed in full and atl required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �2-� ����'^�� ��' <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 1 AP�UC—��O— � 4 �-,C�'Z�+'� <br /> Name: ��'� p � � �,��� <br /> State License# �°� _ Expiration Date. 70�� <br /> 2- � office cell <br /> Phone: ' � <br /> Mailing Address: Cit : ' -�-tt, ZIP: �-�7 <br /> Applicant is: Contractor I Ho owner (Circle One) <br /> Contact Person: w�. � <br /> Email andlor Fax: ` �' <br /> PROPERTY OiNNER INFORMATION: <br /> � � � <br /> Name: � <br /> Phone (day): � C�3� —2 <br /> Address: a„ Cit : �— ZIP: <br /> Email and/or Fax <br /> �%"�'� ARCHITECT! ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): Cit : ZIP: <br /> Address: <br /> Email and/or Fax: <br /> ! PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� <br /> Water Supply <br /> Sin le Famil with Residence <br /> ❑ ew Construction � 9 Y <br /> ,�Addition attached garage ❑ Garage I 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. ❑ <br /> 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.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �o� <br /> Last Updated: 4/26/2011 <br /> - 19 - <br /> -�: <br /> __ .,.A d <br />