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, , � / �� <br /> � � 1 � <br /> C it of �v � '� <br /> y Orono � <br /> � �� <br /> Bu�lding Permit Application ..� � , <br /> for New g <br /> Structures or Additions <br /> Mailing Address: <br /> /�'�+�.� POBox66 Permitnumber: 07��o'Qb�f/0 <br /> 0 �� Q� Crystal Bay, MN 55323-0066 Date received: lo "�— �� <br /> � �'` ?��'�y � Street Address:' Received by: ��v <br /> `� ,' �:..�> C <br /> � , �� �� 2750 Kelley Parkway 303 39 �� � <br /> Plan review fee: i <br /> t9kE6Ei�g'� Orono, MN 55356 �O/D –QD O �� <br /> Totai Fee: <br /> Main: 952-249�600 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 wiil be returned. (Please printJ <br /> GENERAL INFORMATION: �� � <br /> Job Site Address: ����->' �- �SS 7�a�� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes, a special event permit rs required with Police Department and City Councr/approval 60 days prior to the event. Shuttle bus service wil/be <br /> required unless applrcant demonsfrates sufficient on-site parking rs available. Non-permitted evenfs wil!not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: �� <br /> Name: ' ' - �: c.�A� — Kl�S SSOG[�z�5 <br /> State License # o`�,Q�'3 Expiration Date: 3 j <br /> Phone: �(�--- �2--- ��3c� � (office) (v5(- �1'� �5oa (cell) <br /> Mailing Address: !P �j Cit : '�ZoS�v'( C1.� ZIP: (I � <br /> Contact Person: ,�2L��S S Applicant is: Contractor / Horneowner (Circle One) <br /> Email and/or Fax: �-�' _ "� _-7 scs S- G c�r � � q� �c-�r s , L�-,,�,� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ����� ' `� �G <br /> Phone (day): <br /> Address: l�',�� �,����s� ��, �D City �`j p�-�1a ZIP� <br /> Email and/or Fax <br /> ARCHITECT/ 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 & <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 ara e <br /> ❑ Other. (specify) �'�•- ��ASc�v� g 9 ❑ Office/Commercial ❑ Private Sewer <br /> ❑ 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.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ '3� <br /> Last Updated: 9/29/2009 <br /> - 17- <br />