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, � � ,��� <br /> ' 1� 'O.`�j <br /> � <br /> , City of Orono <br /> Building Permit Application �� <br /> for New Structures or Additions �q� � <<�j r.���� <br /> Mailing Address: Permit number: � % / <br /> .¢,�,�. PO Box 66 <br /> O O Crystal Bay, MN 55323-0066 Date received: g-�' 1 Z. <br /> ,� � z' �, SfreetAddress:' Received by: �S <br /> '$'�, ° " Gtiti 2750 Kelley Parkway Plan review fee: ��Y . �`� C� <br /> L9AESHo4'� Orono, MN 55356 1 <br /> — Total Fee: a��a —DO 7 <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: 3 3 5 o a� S����+ Q���o �'"�'`� '�S 3�5(� <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 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 INFORMATIO <br /> Name: S-1,e_�.�� � � (w.�L.. L- �-L <br /> State License# aLoa3� a.� Expiration Date: 3 3 t �o � <br /> Phone: q S�. — �� 3 — S�l 3� (office) (01 2� — �-t I y —5 t 13 (cell) <br /> Mailing Address: ! �3 o M,���-}o�....1�� (31..�1 Cit : u�+� ZIP: "5`�3� <br /> Contact Person: Jv� 1��.•�-r�.-e..r Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: ���,� ;�,�.�s���-4-o r � 5f�,`�.v I.�a P,��I w�c�w - c-o ,,,� <br /> PROPERTY OWNER INFORMATION: <br /> Name: l�1��.-c-y Q,�a�0 5 <br /> Phone (day): <br /> Address: 33�o b—vx. 5+r�e-¢ City: �ro�o ZIP: � � 3�(0 <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) h.i o vi u w,z.,n.�}- ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> *"Any earth movement may require ❑ Commercial �Other(specify) <br /> MCWD review&permits. ❑ Industrial ��:�1t c t�vtC r't� �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 />