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. , . � ,�-�% <br /> U`o.�a <br /> City of Orono <br /> . Building Permit Application �� <br /> � for New Structures or Additions ��� � �_�j c���� <br /> Mailing Address: Permit number: � � � / <br /> Og,�,�.0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: g-�" 1Z- <br /> ,� ,� �, StreetAddress:' Received by: �S <br /> �'�,c, � �,� 2750 Kelley Parkway Plan review fee: l��( . �`� CG <br /> ��ESH��`'� Orono, MN 55356 �v�a ��� � <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 /> tncomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 3 3 5 o d�. 5�r�e.�+ Q�o�o �^'�►J '�S 3�(� <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 approval 60 days pnor to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permrtted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATIO <br /> Name: S},e_�.�..� � � ��„�,,. L�C� <br /> State License# aL oc�3� a..� Expiration Date: 3 3 i �o � <br /> Phone: q�a — y� 3 � S�t 3� (office) C�� a — �t i y —5< <3 (cell) <br /> Mailing Address: !�3 o M,���-}o�,,...1�� (31�d Cit : z.c�+� ZIP: "5`�3� <br /> Contact Person: Jc,� �,��..�-rc�..e...r Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: ��w,.,�,,_i S-E v�-4-o v � 5-F.�;1.�,�v I.Ld Q P Q.I v�.�G�-Iti ' LO i,,,� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �' �wc.y ���a�os <br /> Phone (day): <br /> Address: 33�o d--vx. 5-�-,�.���d- City: �ro�o ZIP: � � 3�� <br /> Email and/or Fax <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 8� <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) h1 v vi c,c w,�,n,�)- ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may require ❑ Commercial Other(specify) <br /> MCWD review&permits. ❑ Industrial ��I( c BviC�'l� �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) $ /a , o O O . �� <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />