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,� <br /> � City of Orono <br /> Building Permit Application .� 2� <br /> for New Structures or Additions <br /> CrI�,�� <br /> Mailing Address: c <br /> ��,�. PO Box 66 Permit number. �.�C� ( u�' -� ( i �I � <br /> , _ <br /> 0 O C rystal Ba y, MN 55323-0066 Date received: (��- � ,?- �,�, <br /> � � �, StreetAddress:' R eived by: ��� <br /> „ <br /> ° y ti`� 2750 Kelle Parkwa � <br /> � � Y Y � {�;� C' �. lan reviewfee: - n� �� r � <br /> �`�kEsxog'� Orono, MN 55356 �---____ - �-��►'� <br /> � Total FeeR� �� , '�; !. <`- <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. `� ����� � ��f <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> JobSiteAddress: �-���� /����� �• ��,1C..� /�C<<1�cr� ��:�.1�s�'�-- <br /> Will this be a Parade of Homes, Remo�c elers owcase Home or other Display Home? ❑ Yes 0-tdo <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 /> /APPLICANT INFORMAITION: <br /> Name: ��'�c,���� /�.�C�d�� � <br /> State License# Expiration Date: <br /> Phone: � office cell <br /> Mailing Address: �- �1�„t� Cit : r v'�„�.� ZIP: - -3� <br /> Contact Person: �� ce- .1 -���� � � ��Applicant is: Contractor / omeowner �c���ie o�e� <br /> Email and/or Fax: � ��;��{-�a��� E� �� ; .�,� , ,,� �j- <br /> PROPERTY OWNER INFORMATION: <br /> Name: �'lr_.r��<> /11C����'-'- <br /> Phone (day): g � <br /> Address � � � ( • �, � ,� � Cit : ��1.J`������������ ZIP: �3 <br /> Email and/or Fax . c '� r.� <br /> ARCHITECT/ENGINEER INFORMATI�: /J <br /> Name: ;�r ,.:'c>^�' � !�� �� /Co� �.2 <br /> Phone (day): � —,� ,�r S ,� <br /> Address: 22���� �, ��,�l�v � City:�lf��c.-��/ ZIP: �S ��� <br /> Email and/or Fax: �,,. / � ��- ,.t��,, , L��,�-� <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. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation l . detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other. (specify �F u�'� C�Cc�' r�/ ❑ Multiple Family/Condo ❑Warehouse <br /> �r C( / ❑ 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 /> i��_ <br /> Estimated Construction Valuation (excluding land) $ �Sf�'�' <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />