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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> - -- Mailing Address: Permit number: �G/l— Oa�� <br /> ?�v D,j�'�� PO Box 66 <br /> "� 0\� Crystal Bay, MN 55323-0066 Date received: �S /� <br /> � � Received by: �'l� T <br /> �'a ���✓�;� �.� �,�� Street Address' <br /> �� �� ��, ���� 2750 Kelley Parkway Plan review fee: �p �- �� <br /> ��`�kEssoj� Orono, MN 55356 ���— ���� <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 s� �mitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: r ,y1t� .�Jf ,S� <br /> Job Site Address: �„S� �vX -Sf • . �rc�ti� . � 3 <br /> Will this be a Parade of Homes, Remodele s 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. Shuttl bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted evenfs will not be allowed. <br /> CONTRACTOR/APPLICA T INFORMATION: <br /> Name: ���'��5�1'�v�C �E/►�v�t�r�-�q� �.L <br /> State License# �� c��� Expiration Date: .�j 3t I Z. <br /> Phone: ��,s��;a���'1� (office) �i'Z- 7�v SYSo (cell) <br /> Mailing Address: ,�7'�5 �'lohfic.:C %~(V� Cit : Sl--� ZIP: 5�y/l� <br /> Contact Person: '�„� t�S�K�u Applicant is: ont� r�/ Hom�owner (Circle One) <br /> Email and/or Fax: -t;,,�, rJ ;NocdS�une- rCy���'Gi�'i�c�, _ W,�,� <br /> PROPERTY OWNER INFORIV�ATION: <br /> Name: JCta 4 C�,�,'�fii�t�'— �'I�i�wiqu�5�' <br /> Phone(day): �SZ 2 y� �.Z�y <br /> Address: Lu-�O F�x S'*, Cit : C�v-��.� ZIP: sS,3S(o <br /> Email and/or Fax ��(�„�,,i,,'��-cz -�yy���`��f,h <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �h,� f�(�.ti6�,�E.i- <br /> Phone (day): 9S� �/�.3 �Z�� <br /> Address: p �. �.c• ' 3r Cit : �'� '��1,fi ZIP: $_�3 G ( <br /> Email and/or Fax: Cr�r o �C.v <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&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) $ J 43 �p j'S <br /> Last Updated: 1/26/2011 <br /> - 19- <br />