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� (o� <br /> � , �,� ��� �- <br /> �� �- � �� ql�.7 <br /> �� � City of Orono � � <br /> �Q �.7�� <br /> � Building Perm�t Application <br /> for New Structures or Additions <br /> /�_� Mailing Address: Permit number: <br /> ���.,�.�� PO Box 66 � <br /> ��� , Q� Crystal Bay, MN 55323-0066 Date received: � � �9 <br /> � �. <br /> � �����4 �. �. I Street Address:� Received by: <br /> �'�L�4��g�r�, ���'� 2750 Kelley Parkway Plan review fee: � � <br /> 97fE�SH 4�' Orono, MN 55356 <br /> �O G <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 returned. (Please print) <br /> GENERAL INFORMATION: l <br /> Job Site Address: 4-9 7 c /� v�-�. <br /> Will this be a Parade of Homes, Remodele s Showcase Home or other Display Home? ❑ Yes No <br /> /f yes, a specia/event permit is required with Police Department and City Council approval 60 days prror to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-perrnitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMAT�Q N: i <br /> Name: ,,,, T r..�a L V tc� �v�.�� 1..t� -� <br /> State License# �p� � g— Expiration Date� O�-- � <br /> Phone: -�. - C� -t� d c{. office) �j �- 4 ��- G 1 o cell <br /> Mailing Address: �M ;� � Cit : ;� ZIP: $S 3 <br /> Contact Person: ,' ,s� ,,, �- Applicant is: Contr / Homeowner (Circle One) <br /> Email and/or Fax: i�S .S� �g '� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ,S �-a�,, S �a� C�% <br /> Phone (day): _ /7,C <br /> Address: ✓�� S � / � J/Y �`r Cit � <br /> Email and/or Fax ��'� ZIP� <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 /> ❑ New Construction Water Supply <br /> ❑ Single Family with �'Residence <br /> [e}Addition attached garage ❑ Garage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> ❑ Other: (specify) ulti le Famil /Condo ❑ Private Sewer <br /> P Y ❑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 /> Estimated Construction Valuation (excluding land) $ (�, GG <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />