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, '� (� ����� I� <br /> City of Orono � ��� S ��,,,�� ��� 1 <br /> �.� <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailin Address: <br /> ��,0,�.� PO Box 66 Permitnumber. v�Oj�—�"0 `�� <br /> i0 \ Crystal Bay, MN 55323-0066 Date received: ?�l�� / <br /> / �� ti.. � � <br /> � � Received b <br /> 1��,a �``�''����•::� a,�, Street Address: � <br /> ���`,� � �xt� G� � 2750 Kelley Parkway Plan review fee: �,� , <br /> '�R�°' ���'r�� � Orono, MN55356 <br /> \,� <br /> ,kEsi�a4j <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: <br /> Job Site Address: ,2,sg 7Z K�1�Y Lc 0(Zp,v�, u��J <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No <br /> /f yes, a specral 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 rs available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: Tc�N�✓ 1�3�3 <br /> State License# �,,� Expiration Date: <br /> Phone: ��Z-S 1 Y- � (03 �e�) (eef�) <br /> Mailing Address: _ ��� Qc.f.�5�✓r /�-✓{� Sou-�r1�1 City:w�rN�v�Us ZIP:�,'�y�c� <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFOFtMATION: <br /> N a m e: ��—L�_ L✓6�-�E <br /> Phone (day): � / 2 - ��-5�- �3 63 <br /> Address: y�-/o 3 �o uNri�'-f c�c-cL� ►� CitY F�l�A- ZIP� 5���/2 �/ <br /> Email and/or Fax c..��E e ,4..H � �u,�q��. c�� <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 ❑ Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building �ingle Family with ❑ Deck <br /> ❑ Relocation � detached garage ❑ Office/Commercial ❑ Private Sewer <br /> D�her. (specify) �7D,�v�t�ET'JS ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ St age ❑ Public Water <br /> ""Any earth movement may require ❑ Commercial ther(specify) <br /> MCWD review 8� permits. ❑ Industrial t��Tlco ❑ 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) $ /,3, DDD .�O <br />