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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> �__� Mailing Address: Permit number: �C�'�� -� �����3 - <br /> //O��,j�.O\ PO Box 66 <br /> 1 Crystal Bay, MN 55323-0066 Date received: � / <br /> � ��'�- � Received by: �f� <br /> �� � ? �,jl Street Address:' <br /> �,c, � ti�' 2750 Kelle Parkwa r� 7 � `x'`� <br /> 7 C'�. r <br /> �t�4 G /� Y Y �I�- �fZ�C E::�S ,L rl ��8f1 f@VI@W f28: � (���. � CY)33% <br /> ��t �� Orono, MN 55356 � � � <br /> �?t'Esxo4`= <br /> �'---" Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �j,�'F�� ��� �,� � 7� <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: 32�,� (�R�-H�l��'t �{(LL �� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> lf 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 1 APPLICANT INFORMATION: <br /> Name: 'f}�r✓1�S '�KEN �N�►+�t+tS i IN� <br /> State License# Z�l�?} �-}y Expiration Date: Z c� i ti <br /> Phone: ��S z_���5 _ �17 7 (office) ('�t Z -75t�- Sbl o (cell) <br /> Mailing Address: ` p7'3 C+1 ��7l�TA- Wv � Cit :Lr�,��i [,�FK-� ZIP: S3S(v <br /> Contact Person: �"anrl Js',Q�",y Applicant is: ontrac o / Homeowner (Circle One) <br /> Email and/or Fax: �,�reor ��ti�.n�.s,��^�,�he;v�z s, c.c ii, <br /> PROPERTY OWNER INFORMATION: <br /> Name: _ �Q�+�g �i G`a.��.it�rry ,��t <br /> Phone (day): ` � <br /> Address: �/p/1� ,¢n,,�.l L/,�� City: �,���7 ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: 'p� }�c.�}y.y <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 �Private Sewer <br /> ❑Other: (specify) ❑ Multiple Family 1 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) $ � , L�'v <br /> Last Updated: 5/21/2009 <br /> -20- <br />