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. !� g� <br /> �� i <br /> City of Orono _ , � � � <br /> � � � <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: D/�—D�, <br /> ��„�0,�.\. PO Box 66 <br /> �O :_: O� Crystal Bay, MN 55323-0066 Date received: �(�� �� <br /> r �sti <br /> �I '`��' � Received by: <br /> a ' �t ,,�, Street Address' <br /> ��'�C, ' ,�z� �ti/ 2750 Kelley Parkway Plan review fee: �`�. <br /> L <br /> l ��� Orono, MN 55356 <br /> �q��s�o�''� �i D ll� D/3�5 <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: ''�oqq /-f����.,�o�,d !L/� <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 allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: l�vo/L� i�fU(�C� �ttn/�.SC�v`�� <br /> State License# Expiration Date: <br /> Phone: G!SZ �- 5�(�- �Co S� (office) (cell) <br /> Mailing Address: ��7 (�_� ly-�h��,�� f.-��� City����/�`� ZIP: ����� <br /> Contact Person: �,g�/� �/t,�� Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: `lie�.iyl�Il�4E i,e4�pS��.�@ �c-��✓�Z�/L B✓G^T- . �1/��'- <br /> PROPERTY OWNER INFORMATION: <br /> Name: �}� � j� 'j=/t,q-/U <br /> Phone (day): �' _ (o p7����k Cv/2 ,(r 3— � 0 2 �/ <br /> Address: ���j�����p� jZQ City: QQpr✓p ZIP: 5���� <br /> Email and/or Fax czs2rQ,� �(` _ «�„ <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: �f.s� �'�c�t-o/� f�B�d�LT�B� <br /> Phone (day): p���S^ �� <br /> Address: 'Z'L'7 �i/� -rjva� ity: ps�'� ZIP: ��� <br /> Email and/or Fax: � ��TS��v�+j i2,��--�����7 ��� <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 /> [�bther. (specify) �`�" !`�c�✓�t- w ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Stora e ❑ Public Water <br /> l�n �7'�l N 9 <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) $ � � Q <br />