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� 1 � � � �� � <br /> � ; G� <br /> City of Orono d � �q so p1� ���'�"' �� <br /> �d.� 5�� wa s s�7" <br /> Building Permit Application <br /> ��� �le� �fir�a����r�e� o� Ae��1o����s <br /> Mailing Address: Permit number. - D .S <br /> �y_O�\ CrysBtal Bay, MN 55323-0066 Date received: �' `�' �.3 <br /> �;t,;..,. <br /> { �, �°?��_,�;` ,,� StreetAddress:' Receivedby: � <br /> \� � � t � � � ' <br /> ;�..�'`�;�a;{„ G� 2750 Kelley Parkway Plan reviewfee: 9c3 �C/ <br /> \r l�R,,;r�T�� Orono,MN 55356 / <br /> R��eKog ao� - <br /> ���� --�" Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 w�vav.ci.orono mn us <br /> This application form must be completed in full and all required information m st be subrnitted. �� /�� <br /> Incomplete applications will be returned. (Please print) ' �6_�y <br /> G�N�RAL IIVFORMA I ION: I <br /> Job Site Address: 1-}(5� �ic G��ti�c�c� � <br /> Will this be a Parade of Homes, Remo elers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes,a special event peimit is�equired:irth Police Depaiiment and City Council approva!60 days�rioi to the event. Shuttle bus setvice ivilf be <br /> requiied unless applrcant demonsfrates sulficient oi7-site parking is available. Non-pennitted events ivill nof be allo�ied. <br /> CONTR!-1CTOR/APPLICl1NT INFORMl�TION: <br /> Name: i�F t 1G��i� �C cSh`7 l Z y1'��_S <br /> State License# ���J���� L Expiration Date: ,., <br /> Phone: � � _ � � � ; 7� office z �-�,�5 cell <br /> Mailing Address: �- Cit : �� �,�; ZIP: , q <br /> Contact Person: Applicant is: ontractor / Homeowner (Clrcle one) <br /> Email and/or Fax: � � �G/ . �- � � �r— <br /> PROPERTY OWNER INFORMATION: <br /> Name: -�`�- . `�r� <br /> Phone(day): �'�':- - i. � � � . <br /> Address: '- y�. �j(` Cit : 1i ►1 ���' /z�i ZIP: .S%�<��- �-- <br /> Email and/orFax S� ' C, (,,L � ; ' � <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 /> Water Supply <br /> (�New Construction �Single Family with �`Residence <br /> ❑Addition attacfied garage ❑ Garage/Accessory Bldg. �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 requ ire ❑Commercial ❑Other(specify) <br /> MCWD review&permits. ❑ Industnal �Private Well <br /> Minnehaha Creek Watershed Distnct(MCWU) ❑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 /> � <br />