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. ' . ' c���5 <br /> � <br /> City of Orono �� <br /> � � <br /> � �� �' <br /> Building Permit Application n � <br /> for New Structures or Additions <br /> l�� <br /> Mailing Address: Permit number: p2 �� 7'" ��3 a <br /> �Q A,O PO Box 66 <br /> `V Crystal Bay, MN 55323-0066 Date received: -���/ `-� <br /> Street Address:� Received by: �c.�6,� <br /> y� ,� 2750 Kelley Parkway Plan review fee: �24 `t g• � � <br /> c,` Orono, MN 55356 <br /> �'9kFs�{O�� Main: 952-259-4600 To#�1 ee: °������30� <br /> Fax: 952-249-4616 www.ci.orono.mn.us L � <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: '`J�:�`� � [�i �'v, C �-_: �� 0/I�'t `'_ ' �����'.. <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ❑ No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shu 1 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: �i���1 i�' �tZ��� ! c�;��1Y�'��C.iZ'e'��, I C. <br /> State License# " .5 "? Expiration Date: , <br /> Phone: cell 1 - � `� �F • -�-5�1�� office r� �, - �r''7 . `"l � <br /> Mailing Address �c� �'�c �c > Cit : �' � r c^ r - ZIP: ` ; "" _��-- <br /> Contact Person: ;tili C 9"1G.k_� ��� t Applicant is: Contracto Homeowner (Circle One) <br /> Email and/or Fax: �Yl �, 1�7 �i YY1Gl,i1C'I,�y-� C;�t['�L�y-i,� c M <br /> PROPERTY OWNER INFORMATION: <br /> Name: �t�C'{a'1 �' ,�.�1'1 P t� v i�IL <br /> Phone (day): � �. �� � 3 � <br /> Address: :� ��- Cit :�iL �C.�, ZIP: ' ' <br /> Email and/or Fax �' }��: U C I� �� �C i C>'-�K� L�. ��'�`ti'� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �uyc�,� .�S/1;:�% <br /> Phone (day): =�St- ��3 •K 3 j I <br /> Address: City:�(,�' �(�f�;;" ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <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 ❑ O�ce/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage (�J Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&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 /> t�= <br /> Estimated Construction Valuation (excluding land) $ �/��G S <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />