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� . <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: <br /> g,�,�. PO Box 66 <br /> �Q � O�� Crystal Bay, MN 55323-0066 Date received: <br /> i � aT <br /> 1 a � ` '�'' �,'! StreetAddress:' Received by: <br /> ;e,_�� � <br /> �'�c, e" �ti 2750 Kelley Parkway Plan review fee: <br /> ��kE3H04'� 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 submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: :��U� �x S%IZh��� �'j 12,ahJ'O <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 approva/60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking rs available. Non-permitted events wil!not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: E��T�S i��li�i�i�/� C.,uIZ� . <br /> State License# ��� Expiration Date: �o <br /> Phone: �'SL-4C1 �y3a� (office) (.�/L -��:s -3 ��� (cell) <br /> Mailing Address: � � �y1�i•l/lJs4„T 3��� Cit : •�,��$/p4� ZIP: ,��.3 1 <br /> Contact Person: ,�U�vJ �',aS Applicant is: ontrac / Homeowner (CircleOne) <br /> Email and/orFax: �,pC. �(Z�i,�`S (�;�il,;,�i�l�. C-u�i�, �bN1 <br /> � <br /> PROPERTY OWNER INFORMATION: <br /> Name: �►'I 1�-+-I A�.� ���O �;�i.fZ1T �4NLI.� <br /> Phone (day): <br /> Address: Z`�' J ��",�KtU��ii.� �j City: O�v� ZIP: S��,�� <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: �-' oC�- �1�L�'���Tlz�.T� <br /> Phone (daY)� �'`�7- � �3:i-"')Z�e�I <br /> Address: City: ZI P: <br /> Emailand/orFax: L��c������f�{���=I-( �'7�C,:7i; it���;L.u��� <br /> PROJECT INFORMATION: <br /> 1. Type of Project I 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 I <br /> �Other: (specify} �°.tzi�i(�C�Fz..L- ❑ 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 I <br /> Deephaven. MN 55391 � <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ <br /> Last Updated: 6/22/2009 <br /> - �9 - v? <br /> '�>. L -�-�^ ,�s� w/� ��=� s-�-� ,4--�,-�c�t cr� c� � r -� - <br /> �, 1 � <br />