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e . , � � <br /> �a��, <br /> City of Orono �o .�� ��- <br /> �� � <br /> Building Permit Application 5 <br /> �I� <br /> for New Structures or Additions ���- � <br /> Mailing Address: •Q� <br /> / PO Box 66 Permit number: <br /> / ���Q Crystal Bay, MN 55323-0066 Date received: -5 ' T <br /> IStreetAddress:' Received by: <br /> y ,� 2750 Kelley Parkway Plan review fee: <br /> F c? Orono, MN b5356 � <br /> �'�kFSEio��' Main: 952-259-4600 Total Fee: ^�O/ ,�S <br /> Fax: 952-249-4616 �v�vw ci cronc���in us l S� <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: ���r�� ��'�%?�- ���I�(> / <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 approva160 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 /> Name: ✓�/.��' c�� �' "a' <br /> State License# ;��'C� 7C�-y-y Expiration Date: �� =- - <br /> Phone: (cell) 9i5- �95 - 7��,j (office) l:�%� %Cr �� G,��'� <br /> Mailing Address: " � �.u� � Cit : ZIP: <br /> Contact Persorr: <-���--,-,;,� , �'�7sc. Applicant is: �Contractor_' / Homeowner (CircleOne) <br /> Email and/or Fax. �y�� <,,��� ��/,�,��y�.�_;�'�� �-��-,�� <br /> � <br /> PROPERTY OWNER INFORMATION: <br /> Name: --/ �2";r�%�/�'/ -� -� /��7;>���� ���c i��Sc�✓ <br /> Phone (day): I�� - � - �� <br /> Address: �'" > - �� � > Cit : �� ��� ZIP: �'�'�� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction r� Single Family with �esidence <br /> ❑Addition attached garage ❑ arage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation ° ,r��,S������i_��'�, detached garage ❑Office/Commercial ❑ Private Sewer <br /> ��Other. (specify)�/IL� �` ❑ 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 /> ^ �7 <br /> Estimated Construction Valuation (excluding land) � • `�2'?2'r% <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />