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. , <br /> City of Orono � ' � <br /> Building Permit Application �� •�i� <br /> for New Structures or Additions `� <br /> Mailing Address: Permit number: ,3-���7�' <br /> ��O�� CrysBtal Bay, MN 55323-0066 Date received: ��/S/,� <br /> �I ��� I Received by: <br /> �,,a t�� ,� �,�, StreetAddress:' <br /> ��',�c, �l �,�� ��/ 2750 Kelley Parkway Plan review fee: �� <br /> \tqg���o�� Orono, MN 55356 �J <br /> ��__--' Total Fee: C��3.�y" <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.rr�n.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: j������/� j��/�� <br /> Will this be a Parade of Homes, Remodelers 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 be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ,Li�yc� � �j � r <br /> State License # �j,j�s��/ Expiration Date: ? 3 G s� <br /> Phone: �� -- �73-�y,-r�% (office) (cell) <br /> Mailing Address: 7J ,fi/��� �o,� City:%�-�%��JJ ZIP: �,Z �;/Q(},�2 <br /> Contact Person: �,�`; �J�S�,,,/ Applicant is: on rac ;/ Homeowner (Cirde One) <br /> Email and/or Fax: �yo,-;-�«_ �", /i���/�sr=r^, Cc�r� <br /> PROPERTY OWNER INFORMATION: -�-� <br /> Name: _��c�v�/c� � -fc���ir�� ��c+Zii�.sc.t/ <br /> Phone (day): �',S'� - �y73 - d 7y,3 l <br /> Address: e5`i�� /�nt�7�P, aQr/� l City: �C��jZ��7�� ZIP: �j�.��� <br /> Email and/or Fax r� <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 esidence <br /> �.Addition 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) ❑ Multiple Family/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 /> � <br /> Estimated Construction Valuation (excluding land) � .�Q, �C�: <br />