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� <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> �� Mailing Address: �r�c� _ �;�-�3 <br /> %g, ,�\, PO Box 66 <br /> Permit number: <br /> '� C stal Ba <br /> �Q Q\,, ry y, MN 55323-0066 Date received: / /' <br /> � ��� �� Received by: �v�� <br /> � �.y., a, i Street Address:' �� <br /> �cn �' f''� ��;� 2750 Kelley Parkway ��� 'pl n eviewfee: ::r� ��/. �j� � �q <br /> 4�/ Orono, MN 55356 �������c �1 �Y'��� <br /> \�ESHo�i <br /> —� Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 wvwv.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: SZ�,S (�TL,�-�,�-1►�t {-� (LG �� <br /> WII this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> lf yes, a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service wil/be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> N am e: T�OM A�S '�"�E Nl �f-��+��.s � C nf� <br /> State License# Z.c+t��i ��}�{ Expiration Date: 2 c� f t5 <br /> Phone: ��Zs475 - 4��7`7�7 (office) �iZ -75z�— Sf�,10 (cell) <br /> Mailing Address v73 �'J t;�A-yC,¢T�4- Wc) �f Cit :,C��F� �,�-K..� ZIP: 53S(c. <br /> Contact Person: �"d�Y i'��Q�y' Applicant is: ontrac o / Homeowner (Circle One) <br /> Email and/or Fax: ,E,�resr ��ti6,y.t�.s,6� �,tief�r s c,c��i, <br /> PROPERTY OWNER INFORMATION: <br /> Name: Qa� .� �v.;,rL1T�'�y ,�/�L <br /> Phone (day): ` <br /> Address: �/p/�� ,¢� G j�' City �r/,��7 ZIP <br /> Email andlor 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 Water Supply <br /> [�Single Family with �Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Re�ocation detached garage ❑ Office/Commercial ,�Private Sewer <br /> ❑Other: (specify) ❑ Multiple Family J Condo ❑ Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review 8�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 /> vdww.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � , �-u <br /> Last Updated: 5/21/2009 <br /> -2� - <br />