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C� <br />� - � ��� <br /> � <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailrng Address: <br /> �.+�.�� PO Box66 Permit number: �C� p-Q(`j /� <br /> Q �, QA� Crystal Bay, MN 55323-0066 Date received: � <br /> �s,��� �� <br /> ,� I��'�����' �) Received b <br /> , �,,�, s. Street Address:' Y� <br /> �c� ��''�' �.� �� 2750 Kelley Parkway � <br /> l � � '� � Plan review fee: <br /> �kE5Ho4�' Orono, MN 55356 <br /> Total Fee: �j�� �O <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: L..l�� q �-,�q ��� �� <br /> �, � <br /> Will this be a Parade of Homes, Remodelers Sl�wcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a special event permit is required with Police Department and City Council approva/60 days prior to the evenf. Shutt/e bus service will be <br /> required unless app/icant demonstrates sufficient on-site parking rs available. Non-permitted events wil!not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: V�o od V�l o,r�JC �� v�� ,•�-1-rT, I v� L <br /> State License# �06 �-�->o i Expiration Date: 3�31��► o <br /> Phone: � 5�-a o 1-��i 3"� (office) (cell) <br /> Mailing Address: 23z� �a,,,,�,oo� �,� Cit : <br /> un ZIP: 56 b <br /> Contact Person: ,�l.,S�e ,,��,A„�„(,' A licant is: ontrac or Homeowner <br /> Email and/or Fax: �� pp (Circle One) <br /> PROPERTY OWNER INFORMATION: <br /> Name: �(Y1 a,rK IC.���,, <br /> Phone (day): ��t�,- ���� <br /> Address: L}�y�� �.��, h,}, �� City� ('�r-r,,� �, ZIP� 5'� � � <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <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 /> ❑ New Construction Water Supply <br /> ❑ Single Family with [�'Residence <br /> ❑ Addition attached garage ❑ Gara e/Accesso Bld <br /> ❑ Accessory Building (� Single Family with ❑ Deck9 ry g' � Public Sewer <br /> ❑ Relocation - detached garage ❑ Office/Commercial <br /> ❑ Private Sewer <br /> �Other: (specify) �!� � ❑ Multiple Famity/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) $ �f70 DO <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />