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<br /> City of Orono
<br /> Building Permit Application �g� • ��
<br /> for New Structures or Additions
<br /> / Mailing Address: Permit number: �cQ - �Q
<br /> , �pNO Po BoX ss
<br /> Crystal Bay, MN 55323-0066 Date received: :5-
<br /> '� Received b �C.� S
<br /> I � Street Address:' Y�
<br /> '�;� �l 2750 Kelley Parkway Plan review fee: I Z7 � •
<br /> ��,\ c,` � Orono, MN 55356 ,���� _ ��Y y
<br /> ����E�sr+���� Main: 952-259-4600 Total Fee:
<br /> � 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: 335� E-or. `�'tv�e-�-� �-ov�� l���e M1J ta�3'�aCP
<br /> ____._____.____.___ � _._._.__
<br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Di—splay Home? ❑ Yes �,No
<br /> 1f yes,a special evont permrt is requirod with Potice Depariment and City Council approval 60 days prior to ihe event ShutUe bus service will be
<br /> rQqurred unless applicant demonstrates su�cient on-site parking is available. Non-permittad evQnts will not be allowed.
<br /> CONTRACTOR/APPLICANT INFORMATION:
<br /> Name: J. vJooc��ro..� L-�-L-
<br /> `----
<br /> State License# P,,,�c., to1"1 �{95 � Expiration Date: 3 J� � f 2,p�(�
<br /> Phone: cell Co�2 - -t g � - �`\ office S�.,�..
<br /> Mailing Address: Z82q '��c.L.o �c�r� S . ___ Cit :�}-. Lou,s . ZIP: ��yZtv
<br /> Contact Person: �o� ,,,,,,�,�,�„Y .�,,v Applicant is: ontrac / Homeowner �c���ie o�e�
<br /> Email and(or Fax: _ '� � �,,,oc��vou..� _.L...s-t�ov�..L�ow.ea -c�,,,,.
<br /> PROPERTY OWNER INFORMATION:
<br /> Name: t�av��y �3��goS
<br /> Phone (day): (pl'Z. - "10 � - �'0�,'� ---
<br /> Address: �,3�o Fd�c S�. Cit : l.ov+o�o..�� ZIP: �'�'3�(0
<br /> Email and/or Fax ��w ��,G o� �,G,,.�oo . C_o w� _
<br /> ARCHITECT I ENGINEER INFORMATION: q�
<br /> Name: _ Arda...,...._ (3�.r r���to,.� � �.51,�,�t...G,.�. V�2..�o ti�h _
<br /> Phone (day): l$i2,. -1 g� - g�y��
<br /> Address: �oo �. Lc,,,lc� `�;-. �}�. Zpo. City: vJ�y -z.c.r-Fc,,, ZIP: "S5"3�____
<br /> Email and/or Fax: _ c�c�„�•,kj(c�J e�ku.c�ne.. -�m ____�
<br /> PROJECT INFORMATION: Description of pro�ect:
<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 /> ccessory Building ❑ Single Family with ❑ Deck
<br /> Relocation detached garage ❑ O�celCommercial �Private Sewer
<br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse
<br /> ❑ Public ❑ Storage ❑ Public Water
<br /> "'Any earth movement may require ! ❑ Commercial �pryhPr(snecifv)
<br /> MCWD review&permits. ❑ Industrial ti'n�� G���-��.- ❑ Private Well
<br /> Minnehaha Creek Watershed District(MCWD) �Other: (specify)
<br /> 18202 Minnetonka Blvd �
<br /> Deephaven,MN 55391
<br /> P hone: 952-471-0590
<br /> Fax: 952-471-0682
<br /> www.minnehahacreek.or
<br /> Estimated Construction Valuation (excluding land) $ Z�JO, 000, o�
<br /> Packet Last Updated: 04/19/2013
<br /> Page 22 of 23
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