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. . r�-'.�--�/�/ I�� � <br /> J REC�IVED <br /> ��`� Ci of Orono <br /> � JUN 1 4 2012 <br /> ��� Buiidin Permit Application <br /> g CITY OF ORONO <br /> for New Structures or Additions <br /> __-_ Marlin Address: � {i �? l <br /> � � PO Box 66 Permit number * �'j � - ' � <br /> � � � i�r�.�.� i- � / ��:� <br /> ;�'� O Crystal Bay, MN 55323-OQ66 Date received ,, ;;....: � -i <br /> i � � ' � � , � , ;�� Received b : L-L <br /> �, ��rJ�� _ a� Street Address:' , ;; ;�: y �._, _,-�.�. � ��-�. -.-� "3 <br /> \�.�, ��� � '� Gti�' 2750 Kelley Parkway �-��=�_�( +•� Plan review fee: , � � <br /> t `'��+��, Orono, MN 55356 ���.��{ ` ' <br /> ���ti�sgp4`�- � <br /> '_- - Total Fee: D <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orano.mn.us , <br /> This application form must be completed in full and al!required information m be submi ed <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: �I � �, <br /> Job Site Address: <br /> Will this be a Parade of Homes, Remodelers Sho se Home or other Display Home? Yes o <br /> If yes,a specia!event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non permitted events will not be allowed. <br />' CONTRACTOR/APPLICANT INFORMATION: <br /> � <br /> Name: 'r -�v � � �. �„ <br /> State License# �"' Expiration Date: �`'1�� <br /> Phone: 2 2 ' o�ce cell <br /> Mailing Address: � ���f M� Ci : ZIP: <br /> Contact Person: ;,r: �"a c hS ov.. Applicant is: ontrac / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFO��T(ON: <br /> Name: �,r� -f� <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: Ciry: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑New Construction �'jSingle Family with ❑ Residence <br /> ❑Addition attached garage ❑Garage/Accessory Bldg. ❑Public Sewer <br /> ❑Accessory Building ❑ Single Family with k <br /> ❑Relocation detached garage ❑Office/Commercial ❑Private Sewer <br /> ther: (specify) -� ❑Multiple Family/Condo ❑Warehouse <br /> ❑Public ❑ Storage ❑ Public Water <br /> ""Any earth movement may require ❑Commercial ❑Other(specify) <br /> i 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.minn hah r ek. r �— ---�- -- ` <br /> $ vJ •�' 1,. <br /> Estimated Construction Valuation (excluding land) ��� <br /> � <br /> Packet Last Updated: 03-06-2012 ; <br /> -2 - <br />