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. `� / �-- � <br /> ' � ��I � Cit of Orono i\ <br /> Y I � <br /> � �� n � <br /> Buildin Permit A lication �' � � <br /> J pp "t� <br /> for New Structures or Additions <br /> � <br /> Mailing Address: � <br /> O�, ,�.Q PO Box 66 Permit number: — <br /> Crystal Bay, MN 55323-0066 Date received: � ;,1 <br /> ,� ��\���` � Received b <br /> � :,`+ �, Street Address:' y� <br /> �'.F, ��� oti 2750 Kelley Parkway Plan review fee: J� � . � <br /> t�kESHOg'� Orono, MN 55356 <br /> Total Fee: a�l��Ud� <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: T'L'7�� k�� ! v �•��� <br /> Will this be a Parade of Homes, Remodele�s 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 sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: '{�v�v r►�r� �i�c�C�� �►-rr.�-� �-✓)�. <br /> State License# '�p�3��`7 �j Expiration Date: '3—�I-�^?S71 Z <br /> Phone: '��3 —'�.i.w�q�'Zca.�'� (office) (cell) <br /> Mailing Address: �o �,� '37'� City:���r,o ZIP: �_ <br /> Contact Person: ° � Applicant is: r o�acfo� / Homeowner (Circle One) <br /> Email and/or Fax: � Q�,� ,.Y,h r i c �,rru��M n . �m <br /> .—�- _ � , <br /> PROPERTY OWNER INFORMATION: <br /> Name: �m� <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT I 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 ❑ 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 8� 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.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �:�� <br /> Last Updated: 4/26/2011 <br /> - 19 - <br /> S�,�� <br /> �'y <br />