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� u�. .23-0� <br /> � <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> �-�—� Mailing Address: Permit number: �Q� � <br /> /�,�,�\ PO Box 66 �// D <br /> /� ,: Q`� Crystal Bay, MN 55323-0066 Date received: 9 <br /> i ����.� L�S <br /> � <br /> I a ��'j�. �.�.`.,:; �,;� Street Address:� Received by: <br /> �'�n '�� '� Gti j� 2750 Kelley Parkway Plan review fee: , ��� a� <br /> t�kESH04�' Orono, MN 55356 plan RGv�tiv Pr,� � oo _-aa �9 <br /> - Total Fee: _ <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us ;'a � <br /> This application 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 D�� �-f� �(-�l,✓ oC�(� �Z,� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [� No <br /> /f yes, a specia/event permit is required with Po/ice Department and City Council approval 60 days prior to the event. Shuttle bus service wi/l be <br /> required unless applicant demonstrates suffrcient on-site parking is available. Non-permitted events wil/not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ?jll� wao� ���n�+i3En- ���ES <br /> State License# Expiration Date: <br /> Phone: (,<-,�_ •PLa,p�5��3Y�, 298 ..OG (office) � -Z7o - �6,�3 (cell) <br /> Mailing Address: y�y,� Ea,r -7� 5rrt� '�" City: �7- P,¢��,.. ZIP� ,�;�o � <br /> Contact Person: �i K� l��c K c.-A�5 Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: (0 5( _ 2� `'d- O b3� <br /> PROPERTY OWNER INFORMATIO C <br /> Name: � L. �, ��'"N �E Jc12�N <br /> Phone (daY)� cac -L , (�Z3 -CoR92 ?(o3 - �G`-�-�4( �- <br /> Address: l,�pq� y���{,,.ra,y� City: O�/�0 ZIP: �s36� <br /> Email and/or Fax _ �t gQrc�,n � q v'c��o . c,e �,c.� <br /> � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ��Cc�-,��p/, <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 arag /Accessory Bldg. [�Public Sewer <br /> Accessory Building ❑ Single Family with ❑ c <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& 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) $ k�,�;.;�; � <br /> -20 - <br />