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, . , <br /> l7�-' <br /> C City of Orono <br /> ���\� Building Permit Application <br /> for New Structures or Additions <br /> —� Mailing Address: � <br /> .�� Permit number: � O�� -�G,3� <br /> 0 y_O�Q CrysBta�Bay, MN 55323-0066 Date received: � �%�3 � � <br /> � °,:�� <br /> ��°= ' Receive�-�- L� <br /> ,� , � -,� �, SfreetAddress:' __. <br /> �'�,s, ` ''�� �,ti 2750 Kelley Parkway ��P I 'CC`,3 7,S Plan review fee: � �� . �'1 <br /> t`�kEsxo4`� Orono, MN 55356 <br /> � `- " Total Fee: / C�/ '7�J <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.nin.us ( �P � <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: �<I F�'r,,,���1 �;r�r°!'-� ��,� � t <br /> Will this be a Parade of Homes, Remodelers Show ase Home or other Display Home? ❑ Yes No <br /> ff yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: d��-�� ' <br /> . <br /> ,�,,�>v�-z- �u �,.,: �;�." y���,'� � L L C: <br /> State License# c}U 5 7�3 31 '� Expiration Date: - <br /> Phone: -- y , -�) ' office -7L� � - �' -- `5/Cl cell <br /> Maii�ng Address: `11��; �;cs�e��� 7�c�r CitY � �r �:-,�i'�f� ZIP: 5�S 3S 7 <br /> Contact Person: j,,�,(�,( �e��,/� Applicant is: n ractorA / Homeowner (CircleOne) <br /> Email and/or Fax: rv� Q�T/' � � f✓<<L,nr� , Gn;�Y� <br /> PROPERTY OWNER INFORMATION: , <br /> , � <br /> Name: (��'�;:��" �.«��:d �l"1,� ; � ���l�(�v i� 7 <br /> Phone (day): F,i ���- �� - �yY�G' <br /> Address: 51 tfclGl��c�°j�9 �f;�� City: �%��f�, �;; ZIP: �� >�� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction � Single Family with � Residence <br /> �j Addition �1(�e ��'�'�u'��� attached garage ❑Gara e/Accesso Bld <br /> g ry g. �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ 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 8�permits. ❑ Industrial `T�jr�.�' `�c-ccS�� � 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�71-0682 <br /> www.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ /J, ��rl `"� <br /> Last Updated: 4/26/2011 <br /> - 19- <br />