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Rpr 22 14 ,07: 41,p Dupont Construction 763-413-2614 p. l �I� ��.� CITY OF QRONO N� � BUILDING PERMIT APPLICATION � ��' FOR NEW STRUCTURES OR ADDIT[ONS % ^, Mailing Address: Permit number a D( � ��'VO PO Box 66 � �� Crystal Bay, MN 55323-0066 Date received: -�,3 � �y- � f Street Address:' Received by: J�CJ-� ;'r� ! 2750 Kelle Parkwa (p7• � I P�l � C� `` � Y Y Plan review fee: `��,lkf t+J�`� Orono, MN 55356 �]�� , ��3s� Total Fee; Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: Cj SS�jCj Will this be a Parade of Homes, Remodefers howcase ome or other Display Home? ❑ Yes No I(yes, a special event permit is required with Polrce Department and City Council approvaf 60 days prior to the event. Shuttle bus servic ill be requrred unless applicanf demonstra[es su�ficient on-sife parking is available. Non-permitted events wifJ not be allowed. C�NTRACTOR!APPLlCAN7 INFaRMATION: Name: ��' ��.��- CtsvtStYLtC:�'iC� State License# �GIpb�1 nZ5 Expiration Date: �13�f S Phone: (ce�l) (office) 7�;3 753 `�7 t� � Mailing Address: 3�1�{ E_;c�z� ,n,�Q��SS .St a\I t�'v City:,.�/�_r,-�ctiC�S Z1P: S 507i� Contact Person: �� , � Applicant is: ontract / Homeowner (Circle One) Email and/or Fax: �j^�,iC�4i�Y�� mSn- �.L� ______ ______ PROPERTY OWNER INFORMATION: Name: .S�e Ve P�c�i r�i er Phone(day): �si - ZS3- 7�I( �^ .-.-- Address: 2��5 GI�,�(_{�lC; CcN� ��. City: I"c`n� ZIP: S��`�W Email and/or Fax ARCHITECT/ENGINEER INFORMATION: Name: Phone (day): Address: City: ZIP: Email andlor Fax: PROJECT INFORMATION: Descri tion of ro�ect: f�`�'�"��1� *S�Z�. �� J t�S,QLu� � 1.Type of Project 2. Proposed Use . fructure Type 4.Sewage Disposal 8 �V� Water Supply �{��,p�� I ;� New Construction Single Family with �esidence � � ❑Aadition attached garage Garage/Accessory Bldg. i ❑ Public 5ewer ❑ Accessory E3uilding [] 5ingle Family with ❑ Deck 6e `f d'� gRelocaTion detached garage ❑Office/Commercial ❑ Private Sewer ��-��o �( Other: {specify) ��. ❑ Multiple Family/Condo ❑Warehouse / ❑ Public ❑Storage ❑Public Water ��y//� ""Any earth movement may also require � ❑Commercial ❑Other(specifyj � � MCWD review&permits. ❑lndustrial ❑Private Well 5�� ; fvlmnehaha Creek Watershed District(MCWD) ❑Other: (SpeCify) 18202 Minnetonka Blvd Deephaven,MN 55391 Phone� 952-471-Q590 � Fax: 952-471-�682 v,nvw.mmnehahacreek.or Estimated Construction Valuation (excluding land) $ ��V•�U