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.-. <br /> �5 <br /> cit f �� �• <br /> y o Orono `�' <br /> I <br /> Building Permit Application <br /> for New Structures or Additions <br /> — Mailing Address: Permit number: p�Q!�-(7U�Z-� <br /> `�.,�,��� PO Box 66 <br /> j/Q ,, Q;,, Crystal Bay, MN 55323-0066 Date received: �I '�D' �� <br /> i, a , <br /> ��,.� ���✓� ' a,�� StreetAddress:' Receivedby: � <br /> �\�'�,n '� ' ,�, �ti� 2750 Kelley Parkway Plan review fee: ��'J� Qj <br /> '���'�gEs�s�'��� Orono, MN 55356 <br /> ,_ a011-DO � <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 /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: . 33G �'���vpr+LE �i�E <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 approva160 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-sde parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ��R�,v� �qr►��5 �cn�s�urt��ow <br /> State License# �C�S 3 i q(:r I Expiration Date: �-31-0?0�3 <br /> Phone: ���,;3� y7q - 3)� 7 (office) �w��� 3�`(-3�3 G, (cell) <br /> MailingAddress: po �c+X o� Cit : ��PLE P��r•v ZIP: 5535`1 <br /> Contact Person: �� �t?c pt+E�so� Applicant is: ontractor / Homeowner (CircleOne) <br /> Email and/or Fax: ;�.� /� ;_�e�,_ ��,,�,tes, c E H-► <br /> —�—�- <br /> PROPERTY OWNER INFORMATION: <br /> Name: �I/Ic K � �E�v�vY Pir-rnwDS <br /> Phone (daY)� ��) C7�� 7G'1- �!3 0 _ __._� - — <br /> Address: j�f 0 R c.5orv �KuJ4' s� 3c�f� City: MvvrvErnvK+� Z�P� S S 3 d S <br /> Email and/or Fax ����,o�as, r�,oads�-� q .,m�II< L:Orr� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: C Y ✓ry CSnJ C �l�' T 5 <br /> Phone (day): ta OFf rc E� Cc�a� �ao- c�i�o (cecc) <br /> Address: S?oU 1��4sN�3un'ti A�E S City: �,�wFppa�r5 z�P: �sy,c <br /> Email and/or Fax: _ �,��� �,s; , cvwr <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 I attached garage ❑ Garage/Accessory Bldg. �(Public Sewer <br /> ❑Accessory Building I ❑ Single Family with � ❑ Deck <br /> ❑ Relocation � detached garage I ❑ Office/Commercial <br /> ❑ Other: s eci ❑ Private Sewer <br /> ( p fy) ❑ Muitiple Family/Condo I ❑Warehouse <br /> ❑ Public ❑ Storage �Public Water <br /> *"Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial <br /> ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 i � <br /> Fax: 952-471-0682 � <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 3)Q , �� �" <br /> Last Updated: 4/26/2011 <br /> - 19 - <br />