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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> MailingAddress: Permitnumber: o?���" ��53 <br /> ,�.¢,�,�.�� PO Box 66 <br /> '� ��V Crystal Bay, MN 55323-0066 Date received: �� - 9-�� <br /> ;% <br /> �' ' ��I Received by: � <br /> �I,� ��r�R� ` �, � StreetAddress:� y39�• <br /> �.�, �;� � ���' 2750 Kelley Parkway Plan review fee: <br /> � <br /> �9k sKog,� Orono, MN 55356 a o��- o�53b <br /> ` — � Total Fee: <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 must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �7j�l� ��,q}� ���L �p�}D <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If 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 a/lowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: 5?e�/G'tr000p L•G. C <br /> State License# 2Q5�`j<j3/5 Expiration Date: 3� <br /> Phone: 6 - 559 office 6� - g6a-4�o cell <br /> Mailing Address: 'j E/tT G. Cit : N��,k buS ZIP: ,5 L <br /> Contact Person: oc. ,t�b Applicant is: ontractor / Homeowner (CircleOne) <br /> Email and/or Fax: ���5 p�-�,�ooCr�,rGDj7? <br /> PROPERTY OWNER INFORMAT ON: <br /> Name: �f�4�2CE � �-l�A M�C�r�r� <br /> Phone(day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax Om�i i �nctG Go17j <br /> ARCHITECT/ENGIIyEER INFORMATION: <br /> Name: �S�C[�G G d fV� BU <br /> Phone (day): 502� 5`}�^ � � <br /> Address: I��l� /''1��u�Ut�Tb.V{t,A LVIJ. c�ty:pd�;�H�y�,� ZIP:�.�v?�� <br /> Email and/or Fax: pG'FGr��1meIG�Sar�hi�'� GoC7� <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 ,$�Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial f$�Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/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) $ �b�;���,� <br /> Packet Last Updated: 10-20-2011 <br /> -20- <br />