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. l,�a 23-��' <br /> City of Orono <br /> Building Permit Appiication <br /> for New Structures or Additions <br /> Mailing Address: Permit number: d�� DD <br /> 4v�,� PO Box 66 <br /> Q �� O Crystal Bay, MN 55323-0066 Date received: ���� 09 <br /> a �°t;�. _ <br /> ' '��;, s, StreetAddress:' Received by: L�1'lJ`i'S <br /> �'�n ' "'� �ti 2750 Kelley Parkway Plan review fee: , ��� a� <br /> t�kESKo4� Orono, MN 55356 pl�.n vttiv <br /> ,�c Pr,�� • _ o��ao �9 <br /> Total Fee: ; <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �"� � `�. � <br /> This applicafion form must be completed in full and all required information must b submitted. '� '"" <br /> Incomplete applications will be returned. (Please print) � <br /> GENERAL INFORMATION: <br /> Job Site Address: � � �('� �-f{ C,�-�c,.i oD � �.'(� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> If yes, a specia/event permit rs required wifh Police Department and City Counci/approva/60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking rs available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> N ame: t3 i (� w a�� '�c�.�+r3 c"r- �Y"t C S <br /> State License # Expiration Date: <br /> Phone: (,S(- �Q����'�3� Zqg �OC, `� (office) �Sl � Z7o - g6,�3 (cell) <br /> Mailing AdGress: �,�,7 E,,�,— -7r� 5� --'C— Cit : �7- p,�}-JL. ZIP� �r;jo j <br /> Contact Person: ,��� �- �1 r c�L�v 5 Applicant is: Contractor / Homeowner (Circle One} <br /> Email and/or Fax: S( - �� Sr- O 6 `j <br /> PROPERTY OWNER INFORMATIOt� <br /> Name: � lr � Kc_'1(� '�� �:�� <br /> Phone (daY): �� 'Z — � L3 -Cv� r32 �f�3 . �G°-{-? 4( �- <br /> Address: L�p �� ���r�o�,� Cit : O��c7 ZIP: �,�3�0� <br /> Email and/or Fax a S er�n e� q r^a�o > �-� vt-� <br /> � - <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: �((�w Qp/, <br /> Phone (day): <br /> Address CitV: 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 arag�/Accessory Bldg. (�Public Sewer <br /> Accessory Building ❑ Single Family with ❑ ec <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> ❑ Other: (specify) ❑ Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑ 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 /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ -��,,�;�;�`� <br /> - 20 - <br />