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~ ° lQ/��� <br /> v <br /> � - � <br /> . ;4 <br /> � <br /> City of Orono �� <br /> � �� �' <br /> Building Permit Application � <br /> for New Structures or Additions <br /> � <br /> Mailing Address: Permit number: p2 ��7'" D03 a <br /> .�O�O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: —/�—/ �{ <br /> StreetAddress:' Received by: �6,5 <br /> � ,� 2750 Kelley Parkway 2� t��', � �/ <br /> y� �� Orono, MN 55356 Plan review fee: <br /> �AkESHO�� Main: 952-259-4600 To� ee: °����i��O`3 <br /> 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 prinf) <br /> GENERAL INFORMATION: <br /> Job Site Address: '�j`j� � i rvi�C� �0� � �-� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ❑ No <br /> If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shu / bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: I.,t�l � c���"�YC.'{C"n.�S ( C � <br /> State License# " S Expiration Date: <br /> Phone: cell 1 - � • �-5SL0 office J - "'1 "� . c� <br /> Mailing Address: O ;x Cit : e� l a ZIP: 5 a7-- <br /> Contact Person: �Mi ChG�t 'F��t Applicant is: Contracto Homeowner �c���ie o�e� <br /> Email and/or Fax: yy� ,'1"7 YYt(.t_Y1�Vh �uC. �.��[ �� �n - <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��,�1 c'' l�� t� v C.k- <br /> Phone (day): 3 <br /> Address � Cit :�1G` CO, ZIP: <br /> Email and/or Fax h0 U C,I[_ u� i U�K. �v� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Gt7 ��n} <br /> Phone (day): '�SZ- g�3- i � <br /> Address: City:�,C(,� �(!�lN�" ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ew Construction �Single Family with esidence <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�71-0590 <br /> Fax: 952�71-0682 <br /> www.m i nnehahacreek.or <br /> (3� <br /> Estimated Construction Valuation (excluding land) � ���� y(3.� � <br /> � <br /> Packet Last Updated.� 04/19/2013 <br /> Page 22 of 23 <br />