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� <br /> � <br /> � <br /> �Cv p � `� City of Orono ,� <br /> � <br /> � � a ���. � <br /> Building Permit Application � <br /> for New Structures or Additions <br /> Mailing Address: Permit number: ��Q <br /> g,�,�. PO Box 66 <br /> � � 0 Crystal Bay, MN 55323-0066 Date received: <br /> �� �_ <br /> a , <br /> �; � , �, Street Address' Received by: <br /> �'�,c, ���~ Gti 2750 Kelley Parkway Plan review fee: 3 .J`f <br /> r9kESH�4'� Orono, MN 55356 ���� _���� . <br /> - " Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 ��:.�w cl orcno i��n 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: � � � G' �wC�''C1 i l S � <br /> Will this be a Parade of Homes, Remodele Showcase Home or other Display Home? ❑ Yes o <br /> /f yes, a specia/event permit is required with Po/ice Department and City Council approval 60 days prior to the event. Shutt/e bus service i//be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP�LI ANT INFORMATI N• <br /> Name: J(XWIf'S t--- � �0 �S ✓,i,i� � � . <br /> State License# 2. � Expiration Date: �, � Z�� <br /> Phone: L � � office � �- �i �S 3 cell <br /> Mailing Address: Ci : \ ' ZIP: .S <br /> �ontact Person: •` ,� Applicant is: ontractor Homeowner (Circle One) <br /> mail and/or Fax: �� ,/' �� � �.�y►1 <br /> PROPERTY OWNER I ORMATION: <br /> Name: S�L� <br /> Phone(day): � � - 2 �� P,� <br /> Address: y '� � � ' � `1 Ci : �� 4'� ZIP: s�(� <br /> Email and/or Fax yv, U. n d <br /> ,._----.-�, <br /> ARCHI EC GINEE F RMATI N• <br /> � 'V\ �. - i G <br /> Phone(day): ��.- �1- Z <br /> Address: r Ci : � Z P: � <br /> Email and/or Fax: •i2- � V 1C i (.Q� <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Pro osed Use 3.Stru ure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction Single Family with Residence <br /> �ddition attached garage ❑Garage/Accessory Bldg. �ublic 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. ❑ Industrial �rivate Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other: (SpeCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952�71-0590 <br /> Fax: 952-471-0682 <br /> www.minnehah acreek.or <br /> Estimated Construction Valuation (excluding land) $ , �,�j <br /> Last Updated: 6/22/2009 <br /> - 19 - <br />