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� <br /> ���P <br /> City of Orono ( I <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number. c�D�Y-'d�5� <br /> � �Q PO Box 66 <br /> 0 Crystal Bay, MN 55323-0066 Date received: - � -/� <br /> l, Street Address:� Received by: <br /> y�V ,� 2750 Kelley Parkway o20((�_ �O s8' <br /> � c,` Orono, MN 55356 Plan review fee: <br /> C�'FESHO�� Main: 952-259-4600 Total Fee: g�' �` <br /> Fax: 952-249�616 ;-onc rr�n us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ;L � Z-o �u,,�v�ro�y 1�`�- • <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �(j No <br /> lf yes,a special event permit is required with Police Departmenf 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 wil!not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: .� E'dt,sK.� �wee��-•+n�v C�Ni`����i�-���'� • Cc�� C-t� �- <br /> State License# '$ G �Z g q �6 Expiration Date: 3-3 r� � <br /> Phone: (cell) q SZ-- Y3 �f3 " 3�'s� (office) °�rL- ��3- 3 6' �'S <br /> Mailing Address: o d o 'b' 2�1 S- Cit : � P: S''3 ,r- <br /> Contact Person: TS t f� Vv�.i Ea e S k��y Applicant is: ntractor / Homeowner (Circle One) <br /> Email and/or Fax: _�hQ��- LP S,,.r �e-�wtq-}-Gr �e �v Sf��c- i e�..t . �a •'1n <br /> PROPERTY OWNER INFORMATION: <br /> Name: eh►V�4� Y Mevyo� ;� � e-���c 11 <br /> Phone(day): 9,r-2-�-�/ - �s-// <br /> Address: �c{Z� l7�,�w wd y City: wf�y'�� ZIP: ��39/ <br /> Email andlor Fax ,;,,��a �a��n�Cr�cc�-rir/. � �"% <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: G(Z� i� Scl•�, p�el' <br /> Phone(day): '7c •— S 6� -- '3 0 �S� <br /> Address: �S'S� �Crdd q�•�.�1 C���� City: S'T. �o,N�` ZIP: .�S37j <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�ect: e/u•=��-� c ��� � �� <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 �,$(Office/Commercial ❑ Private Sewer <br /> [�Other: (specify) �tr`tC°'�'L �" ❑ Multiple Family/Condo ❑Warehouse <br /> P�'c la. a ► � ❑ Public ❑Storage �Public Water <br /> **Any eaRh movement may require ❑Commercial ❑Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) [$Other:(speCify) <br /> 18202 Minnetonka Blvd C h l/y�,� <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952�71-0682 <br /> www.m innehahacreek.or <br /> Estimated Construction Vatuation (excluding land) $ / �� � �n d � O O <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />