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V�i\� <br /> W <br /> City of Orono <br /> Building Permit Application `��SO��S <br /> for New Structures or Additions <br /> — Mailing Address: <br /> .C��� ` � PO Box 66 Permit number: �0/�- D �' <br /> ;,;Oy' �O�,,y Crystal Bay, MN 55323-0066 Date received: `f 9 .2_. <br /> !i �' I • Received b Q�.S <br /> �,,� .,��r �,!? Street Address: Y� <br /> ��`'�' ����� ' 4` 2750 Kelley Parkway Plan review fee: 9S 88 �✓ C <br /> ;,�� „� �x���p�;� � <br /> ���.�x.�, g % Orono, MN 55356 <br /> _ sHo ,- a7oia-aaa <br /> -_–= " Total Fee: <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 re�urned. (Please print) <br /> GENERAL INFORMATION: � C„ ' <br /> Job Site Address: ��� <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 approva160 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sutficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLI A T NFORN�4T� ION: � <br /> Name: �fsSdG/ <br /> State License# 6 - Expiration Date: 3-3 I-1 7i� <br /> Phone: - -/S7'Q office cell <br /> MailingAddress �[�Q� /,�/�¢c/z �¢ � City:S / ZIP: 5��/�- <br /> Contact Person: Applicant is: ��, n`�--� / Homeowner (Circle One) <br /> Email and/or Fax: 7`-�yyt L � .�/ i` �s� ��i�G� � C'ot.v(. `i- �',�/IQI'��J17� .�u�ll��(0(�l <br /> PROPERTY OWNER INFORMATION: � G��� ��''^'��� <br /> Name: ��j/j�2 /�J¢L��/�l <br /> Phone (day): _�S� � _ -��y� <br /> Address: /��-' �� S�i City: �iZ�JL�v ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER IN ORM ION: <br /> Name: ` 4 <br /> Phone (day): - - �c����� � <br /> Address: C c Cit : ZIP: S�'y�� <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) $ �', S"� , <br />