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c. <br /> . , <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> ,—O Mailing Address: a� _pp�33 <br /> �,�` <br /> � PO Box 66 Permit number: <br /> /y- � Crystal Bay, MN 55323-0066 Date received: J�' ,s <br /> �� �� 0� <br /> �a �i=`' - �-.- � Received by: E <br /> ',� �, � Street Address:' Gq, <br /> \ � ��„ �ti 2750 Kelley Parkway Plan review fee: a O I o� • 0 l <� <br /> rykESHo4,,j/ Orono, MN 55356 m,DD9.-Da.3� 3� � <br /> �� Total Fee: B!� <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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ;�y�?I F�y,�,...�s �o;-n f- ���- � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [�No <br /> /f yes,a specral event permit is 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-permrtted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: ✓►-'l��1��.-z� ��� (�u5 C��.s� 7-'�c <br /> State License# �.�o�j� s� Expiration Date: 3- 3i -��„o <br /> Phone: 7.� 7�- 97 L-z �3 � (office) e�L - 7 c� - �i>y� (cell) <br /> Mailing Address: .� 3�6 c_ � � �¢ Cit : � q . ZIP: s �� 3 z� <br /> Contact Person: "�.,.,, C� (j4 S Applicant is: ontracto / Homeowner (Circle One) <br /> Email and/or Fax: d -�a /(� S ��,..z� �.s, _ �c�r <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��,i�< �- �w (�� c� t�..t� � <br /> Phone(day): �S z - 2-�v - ,�3�S <br /> Address: �9�=, ,�z�,,.�,� � PL,� -� �2ti�_ � City: d�-�,. � ZIP: <br /> Email and/or Fax —� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: �� ,,,-z c�. s��� , t�s �� � S <br /> Phone (day): 7� 3 - .�,� y - 3 �� g <br /> Address: a a a ��.n� !, s �r;„-.� City: t,J4,�.<„ /� ZIP: SS 3� �, <br /> Email and/or Fax: � <br /> PROJECT INFORMATION: <br /> � 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� <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) ❑ 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) $ �L�U�p d � <br /> - 18 - <br />