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r - '`/-���`�� . �� <br /> j � � Y <br /> G�"' � <br /> �3 <br /> .� C oa <br /> �; �(��� 1� 2��q , <br /> City of Orono �'�r'�'n <br /> Building Permit Applicatio <br /> for New Structures or A itions �s ,o�, �c <br /> Mailing Address: Permit number: �`�L <br /> Qv 0,� PO Box 66 <br /> 0 * � Crystal Bay, MN 55323-0066 Date received: � a� <br /> �\ ' Received by: �� <br /> a �'t� ;� s, I Street Address:� � , <br /> �' �'o'.,,,�„ ti 2750 Kelle Parkwa -1 ��' S"'� <br /> �9� g G Orono, MN 55356 Y ��`�`''�1�� Plan review fee: "� �� _�� � _ '� � �� <br /> t ESH�� <br /> Total Fee: <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 return d. (P/ease print) <br /> GENERAL INFORMATION: �` � <br /> Job Site Address: ��5 - <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> lf yes,a special event permit is�equired with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMA��N; <br /> ►vame: �-�t�ti��-l-i S cX��s .-�.,.=�N C. <br /> State License# Expiration Date: <br /> Phone: �'j(�3 -�� " --r�l office �f 2 --7 yy-z s-S 4� cell <br /> Mailing Address: � — �`' Ci � � t 1 ZIP: . 5 2..�' <br /> Contact Person: �c S Applicant is: ntract / Homeowner (Circle One) <br /> Email and/or Fax: rr1 r-- - , � C. - —�, •- C <br /> PROPERTY OWNER INFORMATION: <br /> Name: -�S � � �..., j� � (, S <br /> Phone(day): t 5" _ �L q tj'j <br /> Address: �; ��i d,e•� � Cit :�J- � , - �. ZIP: 5 `� 3�t <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <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 ❑ Garage/Accessory Bldg. 0 Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> Relocation - detached garage ❑Office/Commercial ❑ Private Sewer <br /> Other.(specify) ' 1 ' � ❑ Multiple Family/Condo ❑Warehouse <br /> ~ Y ❑ public ❑Storage � ❑ Public Water <br /> **Any earth movement may require ❑Commercial �Other(specify) .' <br /> MCWD review&permits. ❑ Industrial S • �(1� 1.:,:Y -• <br /> ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) �Other.(Specify) <br /> 18202 Minnetonka Blvd -r'j������ �`��� +, <br /> Deephaven,MN 55391 � T <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation(exduding land) $ `�j���jG'�,`�- <br /> Last Updated: 5/21/2009 <br /> -20- <br />