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S ^ • • V <br /> I � ���� <br /> Cit of Orono �`� <br /> Y �, ��� <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �b�D ' (� C�j <br /> -g,� PO Box 66 <br /> � Crystal Bay, MN 55323-0066 Date received: ��7"l0 <br /> �° �� °� <br /> ���a�� <br /> a �`�''`�- -� �,� Street Address:' Received by: , �- <br /> 1�,� � ��,.n,�:� <br /> � ��p_ � � 2750 Kelle Parkwa <br /> t ,����y`��i Y Y Plan review fee: <br /> `�kEsxo% Orono, MN 55356 <br /> Total Fee: �� 3 L.�3 ,� � <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: ,j5��� �'=��--��21 �,;l� n v� K�'C <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �lo <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 INFORMATION: <br /> Name: n1 I C i�/�E 1 1-1.�-�,�;;� j-��,�.,,: <br /> State License# ���3 Expiration Date: _3- 3 i ` J Z <br /> Phone: G S Z - � 7��-5 ��j (office) (cell <br /> Mailing Address: �y 2 � Lc2� c � �'-� Cit��,.,�,v,v c d��1�-� ZIP� �-�-3�;.�,) <br /> Con tac t Person: rn��_ 1.,�,,_,,,� Applicant is �Gontractor�/ Homeowner (Circle One) <br /> Email and/or Fax: <br /> �___- <br /> PROPERTY OWNER INFORMATION: <br /> Name: /���;�2 <br /> Phone (day): <br /> Address: 35Gj F���'�-,,,�Ic City. C»�, c.� ZIP: <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 �1 � ' 3. Structure Type 4. Sewage Disposal & <br /> ��'� ncp� Water Supply <br /> ❑ New Construction ,�Single Family with �esidence <br /> �Addition attached garage ❑ Gara e/Accesso Bld <br /> ❑ Accesso Buildin g rY 9• �ublic Sewer <br /> ry g ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse � Private Sewer <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 <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> F ax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ (�S U��� <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />