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AUG 26,2009 10:22A 9529929289 page 1 <br /> City of Orono � Ca��� ��� _ <br /> Building Permit Application � _ � �S <br /> for New Structures or Additions � � � <br /> Meilinq Address; Permit number: ��1- <br /> Og,D,�O PO Box 68 <br /> Cry9fal Bay,MN 55323-0066 Date received; � <br /> '� � �„ Srreet Address:� Received by: <br /> �, - �. 275o Kelley Parkway Pian review fee: <br /> rqh.�xo�� Orono,MN 55358 <br /> --_ _-- Totel Fee: <br /> Main: 952-249-4600 Fax: 852-249-d618 www.ci.orono.mn.us <br /> 1'his application fortn must be completed in full and all required informalion must be submitted. <br /> Incomplete appllcatlons wlll be returned. (Please prrntJ <br /> GEN�RAL INFORIV�ATION: <br /> Job Site Add�ess; <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> ►f yes,a specia/evenf permit i9 required with Po1ke Depertment end Cay Councif epprove!60 days prior ro the evenr. Shu►tle bus servlce ill <br /> nsqulred unMsa appficant demonshates suthc+ent on-site perking is evallaDb. Non•pe►mltted events will not be el/owed, <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: '�"�� Sfi�D ._... ___ ---- <br /> State LiCense# 20���(p-�t3 Expiration Date; � <br /> Phone: ��SZ, 2�-] , ��{U 2 �(oifice) (cell) <br /> Mailing Address: ��9� � t-Fvv I 01 Cit : �'��� - � ZIP� ��s�7 z� <br /> Conlacl Person: V t C1c� -('e�-c..a►e--o Applicant is: C / Homeowner lcirci.0�.1 <br /> Email and/or Fax: V�urc��•o 4� � uF�f:�t�,.c.� , ezcT,-�� <br /> PROPERTY OWNER INFORMATION; <br /> Name' Z)� �c a►1 <�� ov-�c` --�-� ------- <br /> Phone(day); ia(z � �'+S- I�3'1 <br /> AddfeSS; I 2 4a� �=�c-v�� �rr..�t�. ��r• Clty:�/1��+H ip�;- ZIP' Y.+�?3-..t � <br /> Email and/or Fax ��' <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day); __ <br /> Address: City: ZIP: <br /> Email and/or�ax; <br /> PROJECT INFORMATION: <br /> 1.Type of ProJect 2.Propoa�d Use 3.St�ucture Type 4.Sewage Dispa�al 8 <br /> Water Supply <br /> ❑New Gonstruction ❑Single Family with ❑Residence <br /> �Addition attached garage �Gerage/Accessory 81dg. ❑Public Sewer <br /> Acc;essory Building ❑ Single Family with Deck <br /> Relocetion detached garage ❑Offce/Commerci�,� LJ Pnvate Sewer <br /> ❑Other:(SpeCify) ❑Multiple Family/Conda ❑Warehouse <br /> ❑Public ❑Storage ❑ Public Watar <br /> •"Any earth movement may tequire ❑Commercial �Other(specity) <br /> MCWD review&permita. ❑Industrial I 2x � ❑Private Well <br /> Minnehehe Creek Wetershed Dislrlct(MCYVD) ❑c�ther: (specify) <br /> 18202 Minnelonke Blvd s�l^�r( <br /> Deephaven,MN 55391 <br /> Phw�e: 852�71-0590 <br /> faY 952�71-0682 <br /> Estimeted Construction Valuation(excluding land) S '7Q'�O� " <br /> L3sl Updeled; B/22/2009 <br /> . - 19- <br /> Q��U <br /> / <br />