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` �/�U <br /> � _ " � r <br /> �I��`� C',� <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailin Address: � <br /> /�,L,��� PO Box 66 Permit number: �l� `���10 <br /> ' � Crystal Bay, MN 55323-0066 Date received: � /� <br /> �O ,:, O\;, <br /> � �. <br /> � � <br /> ��,� �'��;�s.' s.J,I Street Address:� Received by: <br /> ���'�,n " �� ��� 2750 Kelle Parkwa <br /> ��,� ��'��. o / Y Y Plan review <br /> ��H�� Orono, MN 55356 ' // <br /> Total Fe : � �/ �Ci_ <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 mus be su . <br /> Incomplete applications will be returned. (Please prrnt) <br /> GENERAL INFORMATION: <br /> Job Site Address: ' � � �" � � �-� �'� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> !f yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will b <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ���v ti �����tii l�� C� �� �i ��n z � / �L� . <br /> State License # � , � Expiration Date: / <br /> Phone: (,� Z - � 10 - � (office cell <br /> Mailing Address: � � — - r Cit : � ZIP: S�5 3�,� <br /> Contact Person: � (Circle One) <br /> _�� ,r � �C ic�n.�. Applicant is: Contracto / Homeowner <br /> Email and/or Fax: �;1 E�;� (� �Z'j„v�;� ,-, ��a �'� ,—�,,,� Na,.nks y C��,� <br /> PROPERTY OWNER�O�f 1�(IATIO� <br /> Name: � �� 1cs�Ey <br /> Phone (day): <br /> Address: �7 S Gc`'��� � C��;u.� �2—. Cit : r`i�t��NU ZIP� � 3�, <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 3. Structure Type 4. Sewage Disposal & <br /> ❑ New Construction Sin le Famil with Water Supply <br /> ❑ Addition � g y ❑ Residence <br /> attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> �Relocation detached garage ❑ Office/Commercial <br /> Other: (specify) Cav�z2- 5 j c.��,� ❑ Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> '*Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑ Private Welt <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) $ 7� �� �-= <br /> � <br /> Last Updated: 9/29/2009 <br /> - 17- <br />