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� � <br /> City of Orono <br /> Building Permit Application <br /> / <br /> for New Structures or Additions <br /> Mailing Address: Permit number: � <br /> .¢,0,�. PO Box 66 <br /> �j����� � <br /> Crystal Bay, MN 55323-0066 Date received: <br /> "3'i rh3Y'�- <br /> �.. . - Received by: <br /> a ; ��; >��i', a, Street Address:� <br /> '�,E, , ' ��� �titi 2750 Kelley Parkway Plan review fee: l v�`'�� �°y P� C C� <br /> l � N� � Orono, MN 55356 ��la' DQ 7 <br /> '�kEssos� <br /> �---_' Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us "' 1•j„j,. � <br /> This application form must be completed in full and all required information mus be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 3350 ��x SfrQet �0 �N SJr <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �X No <br /> If yes,a special event permit is required with Police DepaRment and Ciry 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: S`�1�nC'� �� f�OODP.f mC�r� � �-C- <br /> State License# i��o 0 3� a � Expiration Date: 3 T3 i / 2 C � -' <br /> Phone: GS a -'-��3 — S�-t 3 5 office �v� — i cell <br /> Mailing Address: 1 , ?� Iv11 n►12, K� i3�vC Cit : c( ZIP: S 3�� <br /> Contact Person: J� �� r Applicant is: ontrac or / Homeowner (CircleOne) <br /> Email and/or Fax: C�drnlniSfiu�' � �ne���elm� corr� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �qy���(� <br /> Phone (day): <br /> Address: 3�� �( S City: Q►���� ziP: 553S� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ��ter ����i� � Pc.,�l� �P���..`�nc�l ��r��; ��e.�-� <br /> Phone(day): (o �� — �—`i l�r — 'T�'75 <br /> Address: i4{3�5� M�Kv�u:'tov�k� L��•��1. City: 1.lJcl..�2��� ZIP: �� 3� ( <br /> Email and/or Fax: ,,e.��r� �o-�_ �,-iw�rc_t[5� a�r cL►.�t�c-} - �v �M <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 /> ❑Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage ❑ Public Water <br /> "*Any earth movement may require ❑Commercial -�-9t�ie <br /> MCWD review 8�permits. ❑ Industrial � Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other: (specify) ��` ///��� <br /> 18202 Minnetonka Blvd �h ���` �i v • � <br /> Deephaven,MN 55391 �"� '� <br /> Phone: 952-471-0590 �v���-���Ci°w <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or �L <br /> Estimated Construction Valuation (excluding land) $ , � l O� bC'O .�'� <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />