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� i <br /> �, <br /> - ,: City of Orono .� � <br /> ���`, � Buildin Permit A lication � � ��' � <br /> ' `' �� J pp � <br /> for New Structures or Additions <br /> Mailing Address: Permit number: G�LD� � - v D /� �J <br /> �,�,�. PO Box 66 <br /> � �\ Q Crystal Bay, MN 55323-0066 Date received: o?-!�- I 1 <br /> �',� m <br /> ,� f�j��_s�;'��, ,. Street Address:' Received by: <br /> �'�,r����N!'�.� �� 2750 Kelley Parkway Plan review fee: 020/�- DU /D Z- <br /> `�gESHo�'''� Orono, MN 55356 <br /> �//35. 3% <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 returned. (P/ease print) <br /> GENERAL INFORMATION: ,j � ��,., �— � <br /> Job Site Address: ,-�c ��� � � ��'i� :�� ���C�J�� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If 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-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ��- �- !-ft.�, -r-j� �-�- <br /> State License# 13� - �v.svz � Expiration Date: :��'- - �'�`- �vr � <br /> Phone: .�l - �2 - / 5/J"` office l_� - � j - �j�?�J � cell <br /> Mailing Address: � 5-�- ,x .,� � • ;; :�i , / Cit : ,,�-� ,� /�.-� ZIP: S��3 s� <br /> Contact Person: v e " Applicant is: � tractor Homeowner (Circle One) <br /> Email and/or Fax: ��c�< <' .,1 i`fk.��., , c�-,.., <br /> PROPERTY OWNER INFORMATION:�/� <br /> Name: ��_�' �.� � I'"c�-�1So -� <br /> Phone (day): �TS� — �3 �1 - "7 G G <br /> Address: City: ZI P: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: _fic.;�I T i/� i f,�c,--. <br /> Phone (day): �/„2 - �.r-� - �y�� <br /> Address: Cit : ZIP: <br /> Email and/or Fax: �r,�t��,,,:��✓�^-. � �ol, e�..,,. <br /> � <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 �f2esidence <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 /> fFax: 952-471-0682 <br /> �ww.minnehahacreek.or <br /> E.stimated Construction Valuation (excluding land) $ a/:S ��'tJ.. -- <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />