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Cit of Orono 2� ��� <br /> y .� �� <br /> Buildin Permi � <br /> g t Application <br /> for New Structures or Additions <br /> —� Mailing Address: Permit number: oZOI� '" ��9�� <br /> �v�,�. PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 9 ��—�Z <br /> O �\�` O Received b �6 <br /> � ���� �� <br /> � �, �. ,�_ �, Street Address:' Y� � <br /> � oti 2750 Kelley Parkway Plan review fee: o�0/a�-�49D1 <br /> �, , <br /> L9kESli�4� Orono, MN 55356 <br /> -- -- i36s. �q �G <br /> --- Total Fee: <br /> Main: 952-249-4600 Fax: 952.-249-4616 www.ci.orono.mn.us L,g ��f�: � Z <br /> This application form must be completed in full and all required information must be submittedf 2506 Lp�L-(�(�Q�5� <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: / <br /> Job Site Address: �j�j�ps �jL,�7✓�A2� �G✓c=,� L��lV�� <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 INFORMATION: <br /> Name: YD tJ,.(F�►-7�'1rD �,M�� i <br /> State License# �C(o��67c� Expiration Date: _3`�j/-/3 <br /> Phone: q5�-�(0���4p�(o (office) C�f�-- �-�i - �3']O (cell) <br /> Mailing Address: 2Z2{�v (� D L �. Cit : L.<}}r(,� � �� L ZIP: SSa�{ <br /> Contact Person: �'p�� ���-� Applicant is: ontrac or / Homeowner (Circle One) <br /> Email and/or Fax: �Q$'ad�v-}�c�c�Q c:,�r�c�r}-e!' ,��{- <br /> PROPERTY OWNER INFORMATION: <br /> Name: �(�y�' � (Vl-c:LiSSq ���N1�2 <br /> Phone (day): �$/— �,y3_79/i <br /> Address: jytf �/l,p%hpWqzj //yr. ,�, Cit : L✓Ay2�¢�j�} ZIP: ss.3 t'/ <br /> Email and/or Fax St�l�2 _. b ctrn i e/'.3�� hotn�rv�/ ca iVI <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& <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 <br /> ❑Other: s ecif ❑ Private Sewer <br /> ( p y) ❑ Multiple Family/Condo ❑Warehouse <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 /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ o�'l 3 o Z�'S>�-__ — __ <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />