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r <br />* . M <br />. <br /> � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> %�,0,�.� Ma�bPO Bo�r66� Permit number: a/ - (�(� �� <br /> //Qy � Crystal Bay, MN 55323-0066 Date received: � / <br /> �� <br /> ��a ��,',�''� ` a.� StreetAddress:' Received by: �" <br /> ` �=.�- � <br /> \'�'�c,L��,t ;;t� �ti� 2750 Kelley Parkway ;�a' Plan reviewfee: / /, �� <br /> ����` � Orono, MN 55356 ; <br /> \`?FtESH��`'/ :7�C'//` �t� 7� � <br /> ---�� Total Fee: c� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us ' ��-i ,•;, � �n/`�;� <br /> This application form must be completed in full and all required informafion must be sub ted. � �'l� <br /> Incomplete applications will be returned. (Please prinf) <br /> GENERAL INFORMATION: <br /> Job Site Address: E t �c�� � ' <br /> � '�S r � C,C <br /> Will this be a Parade of Homes, Remodel s 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 e <br /> required unless applicant demonstrates sufficient on-srte parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ���• , _,� ��•U � �•� L <br /> State License# '3�`�� � Expiration Date: `� -'' <br /> Phone: 6 � � �`_���� <br /> S �- �33 r- 3C> office) • � ,,�.3'-_5,' � ' cell) <br /> Mailing Address: 3 � ,��� Cit : � � , • -,LZIP: r � <br /> Contact Person: � ��'" � s Applicant is: � ontractor � / Homeowner <br /> J (Circle One) <br /> Email and/or Fax: ' � �c � c �' " 3 3 -3�� <br /> PROPERTY OWNER INFORMATION: ` ` <br /> Name: I���� 1c:�� � ��b,o.,ll S�l T <br /> Phone (day): � ;` -7-. �r y <br /> Address: �''_ Cit : � ZIP: �'SS'�� y <br /> Email and/or Fax 'y� -�-- � ,�-� <br /> ARCHITECT/ ENGINEER INFORMATION: ���,`����;,��,;�, ;�.asc��. <br /> Name: .�-i ��� �lii1�1[,tA �5��,r.�f < ��-n � <br /> Phone (day): �� - �� "—� � <br /> Address: 3. , ` '� Cit :` >. , � % <br /> / , � ZIP:.�� -s':` <br /> Email and/or Fax: �,��_?� ; '` L`y — ; c�5�, <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 '�f�esidence <br /> • .Addifion attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> �Accessory Building � Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Muitiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review 8�permits. ❑ Industrial <br /> ❑ 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) $ �S.JS' �r;�, �� <br />