Laserfiche WebLink
• * , �� <br /> , � <br /> a<<�I��° — <br /> City of Orono � (�� <br /> � <br /> O1 <br /> Building Permit Application �,aa� oo � <br /> for New Structures or Additions <br /> Mailing Address: Permit number. o���� -��7,j <br /> O.Q,.O.j�,.O Po soX ss —�- 3 10 <br /> Crystal Bay,MN 55323-0066 Date reoeived: <br /> a ' F Street Add►ess:' Received by: <br /> �,�, ^ �ti 2750 Kelley ParkvraY Plan review fee: � � <br /> �.�o$� Orono,MN 55356 0�0/O� (�7$/ <br /> -- Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www ci orono mr-� us <br /> This application form must be completed in full and all required informa6on must be submitted. <br /> Incomplete apptications will be retumed. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 5� �'c' �(-��o �� <br /> WII this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> rrr�,a s�ec►ai e�nr pem►a�s►eyu�d ww�t►►►Pa;oe�a�nne�►r ar,d c►ty ca�np��va►so days w►or ro u►e e�eyn. snutae b�s�oe w�► <br /> requhed uMess applicant aernonsbares s�,/fi«enr on-s►re parldng fs ava/lab�e. Mon-peim�itted e►ns►►rs wiq nor be alrowed_ <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �.9._.:b � �w-'S �� �.l e..`S�.J <br /> State License� Expiration Date: <br /> Phone: 45 - 9 e - oY�ce b�'L� 6`1- ? 4�e cell <br /> Mailing Address: G-t- C' : ZIP: 5 <br /> Contact Person: � .,.a Applicant is: Contractor / omeowner fc�.o�.l <br /> Email and/or Fax: q�z- ��C3• �{13 3 <br /> PROPERTY OWNER LNFORMATION: <br /> Name: PJ►.�t:� tJ�i�S <br /> Phone(day): "1,e''S-1�{��"1�b t <br /> Address: �So +��r L-� �-�. �� CitY= �i,�-�k-t� ZIP: S.�'a�i I <br /> Email and/or Fax �,�E.T��S C�A C�rv�,L.• C.saM <br /> ARCHITECT I ENGINEER INFOR�IAATION• <br /> Name: ��U<<-. �u.--n��" — dVi�►�.�. .I�N'^u� <br /> Phone(day): 9 S a.- Z`t�f- `�S4S <br /> Address: `3a.00 L1t,.*,t�•�--k�7L. �'t'� 1�c7� City:P��W�T� ZIP: ✓�`'S"zt3 I <br /> Email and/or Fax: M,i 1,� � C S c�hn ri C_c�rv� <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Propoaed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑New Construction ❑Single Family with ❑Residenoe <br /> ❑Addition altached garage ❑Garage/Accessory Bldg. ❑Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑Relocation �c.�JJntfo detached 9arage ❑Office/Commercial ❑Privabe Sewer <br /> �Other.(specify) , W�►t'4l S ❑Multiple Famity/Condo ❑Warehouse <br /> ❑Public ❑Storage ❑Public Water <br /> *'Any earth movement may r+aquir+e ❑Comrr�raal $�Other(specify) <br /> MCWD r+eview�pern�its. ❑Industrial ��i6 lr�r� ❑Private Well <br /> Minnehaha Creek Watershed District(MCWD) (�'pther.(SpBCify) <br /> 18202 Minnetonka Bhrd v��,,►�f� 1,�t1S <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax 952-471-0682 <br /> Estimated Construction Valuation(excluding land) ; 11 i Sa o,ao <br /> Last updated: s�zsJzoo9 <br /> - 17- <br /> IL � <br /> n� a �V <br /> � <br />