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. � City of Orono <br /> ' Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: <br /> O�,L,�,�0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> ��.1���� � <br /> � � ����+;. a, StreetAddress:' Received by: <br /> `S� -1 � �ii��" ti <br /> �L � � �� 2750 Kelley Parkway Plan review fee: a , (L 'v�g�- <br /> �'kE6H�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: � ( ,,� �� �, �r . <br /> Will this be a Parade of Homes, Remod lers Showcase Home or other Display Home? ❑ Yes No <br /> !f yes, a specral event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service ill 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: ����,hIL D, � ' ;: �.,.,,.5 Cu��+�-� �v�es - v � <br /> State License# �a��q �w� Z Expiration Date: <br /> Phone: _���as-I —`�7�� (office) (cell) <br /> Mailing Address: �.o. °,�,�c s- � Cit : �,, z �.�� ZIP: � � i <br /> Contact Person: t'l��r 1� �� ,\\; G� S Applicant is:�ontrac � / Homeowner (Circle One) <br /> Email and/or Fax: j�d�' 11 ; �,n�� i��vv.t s � y c,�„r.c� • /�� <br /> � <br /> PROPERTY OWNER INFORMATION: <br /> Name: C i��;s iM� (f� � <br /> Phone (day): �(S�� �SG , a�a � <br /> Address: �l�f �I�,,.i 11,,,:,se �,f Y • City: �-Y� �c� ZIP: S5 3� � <br /> Email and/or Fax <br /> ARCHfTECT/ 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 & I <br /> Water Supply <br /> ❑ New Construcfion �] Single Family with ❑ Residence <br /> i Addition � attached garage ❑ Gara e/Accesso Bld <br /> Accesso Buildin g �Y 9 ❑ Public Sewer <br /> ry g ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> ❑ Other: s eci ❑ Private Sewer <br /> ( p fy) ❑ Multiple Famity/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> '"`Any earth movement may require ❑ Commercial `'�Other(specify) <br /> MCWD review& permits. ❑ Industrial � <br /> ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other. (specify) ����,y,� �`��„o�� <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 � ; „�� <br /> Phone: 952-471-0590 Ir � s���� <br /> Fax: 952-471-0682 c"7/' Il�„Gf rceV� <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ _i��� �,���, �� <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />