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...-� � �.!l 1� <br /> � � <br /> _ .. � <br /> __--..__._._ .0 i�y o��6 ro n o <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: o?U//—Q �1,�, <br /> j�v�,�\ PO Box 66 � <br /> i0 �� Crystal Bay, MN 55323-0066 Date received: � 9 // <br /> I j �� '� � <br /> I,�� ��y't�,�,:;, �,�, Street Address:� Received by: <br /> �` �nt��„�, �� 2750 Kelley Parkway Plan review fee: ���3�o2�U <br /> \gEs�iog� Orono, MN 55356 <br /> - ----� Total Fee: ����—DD�� <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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � �? � � � C S- <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> !f yes, a special event permit rs 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: <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER,I�NF RMATION�• <br /> Name: -" � <M l ` �} L7 fT� <br /> Phone (day): ��2 c� z� � �� c� <br /> Address: ? c/� c� ,� �,�z���---�-- City:f..c()� Le¢rc ZIP•�'S�S�� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: _ Cit : 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 f � detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other. (specify) < <`�/r't U �G L ❑ 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.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � O �j <br />