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� . <br /> � , <br /> . <br /> �d �1 . 75� <br /> City of Orono <br /> Building Permit Application <br />� for New Structures or Additions <br /> Mailing Address: Permit number: /ot—D/ / 7 7 <br /> �i,0,� PO Box 66 <br /> � 0 Crystal Bay, MN 55323-0066 Date received: <br /> � a StreetAddress:' Received by: <br /> ��� G�F 2750 Kelley Parkway Plan review fee: � id-D//7� <br /> �ESHOg� Orono, MN 55356 <br /> Total Fee: 3j �S� 3�j <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: l �(,� �; �:� S-� �'� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? �Yes ❑ No <br /> lf yes, a special 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-permitted events wil!not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: `� i..�.-�,�`���,� :�� <br /> State License# C,�j ;�7 Y� = Expiration Date: /3 <br /> Phone: �, 7 " � ��; ��; office I Z 3 . � �� 5 cell <br /> Mailing Address: c;��� �t,•K,c1 ��� � Cit : � � ,�,� ZIP: S�� - <br /> Contact Person: cc.'�--� �w A,.y x,�., Applicant is: ntractor� / Homeowner (CirGe One) <br /> Email and/or Fax: � �L�� � �,,.��-,��,,.,N,�,�S. ��_� <br /> PROPERTY OWNER INFORMAT�ON:. <br /> Name: J�1� � �,�r c-� ct�r-�k j�N�i�-�� G�So s�I <br /> Phone (day): <br /> Address: ���2� � ,� „� <br /> Email and/or Fax �l' � S��'' City: ��L� ZIP: 55�{(C <br /> �IC �( �.. 2, � l���, �.;_,+� <br /> ARCHITECT/ENGIN�, INF MATION: • <br /> Name: ,Jz ` <br /> Phone (day): _ Z � � <br /> Address: _ �j'i vc= (�..� (}-�,�.,�..r.�. 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 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) $ � �� CTClv <br /> Packet Last Updated: 03-06-2012 , <br /> -21 - <br />