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� . , <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> �� Mailing Address: �, <br /> �� � PO Box 66 Permit number: �� �� <br /> � � �0� Crystal Bay, MN 55323-0066 Date received: <br /> �/� �� <br /> ��ag,,T, <br /> ��,� ����, ��- �j Received b <br /> �,, s, StreetAddress:' y� <br /> 1 � 1'�� o:�.:-',-� <br /> �'�t '` �A^�,� ��F� 2750 Kelley Parkway Plan review fee: <br /> �kESH�4"� Orono, MN 55356 <br /> Total Fee: i 7S <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: ��� �/�' ��;� � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a special event permit rs required with Police Department and City Council approva/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: E N E Rf't� �� a �-�(�,��tiT� - 2an nY �G4t�'►�C� O�J✓le� <br /> State License # _ 22 Expiration Date: �� ' <br /> Phone: (D �2 - 2 $� -�.�. 6�bS� (office) q S 2- 3$ � 2oy � (cell) <br /> Mailing Address: 2 Q h �. 2 Cit : ZIP: 55 3 3 <br /> Contact Person: 1 2 - ✓►z C h Applicant is: rac or Homeowner (Circle One) <br /> Email and/or Fax: q5� _ ci'� - Cb�7� �.� <br /> PROPERTY OWNER INFORMATION: <br /> Name: � Q�t� 2 <br /> Phone (day): _ (op w � <br /> Address: Z 3�1 a��O��hL� Cit C� ZIP� 5�$3q� <br /> Email and/or Fax �(L,F}��.�,(a� M L�S t o,AiV <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: 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 /> � New Construction Water Supply <br /> �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 <br /> ❑ Other: (specify) ❑ Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑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) $ o <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />