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, . � <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Qermit number: p�:r � <br /> g,�,�. PO Box 66 : � <br /> 0 � Crystal Bay, MN 55323-0066 �Date received: � . <br /> a �, Street Address:' Received by <br /> �'�c, � ��`S' 2750 Kelley Parkway Plan review fee: �,� , /�� <br /> ��'k'E3H�4� Orono, MN 55356 ; ����y <br /> "fotal 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: �'L7�� k2� �y �Q��, <br /> Will this be a Parade of Homes, Remodele�s Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service wil/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 mr� ��c�G� T�r�r��, ZYJ�. <br /> State License# '�pU,'3'�� �) � Expiration Date: 3-�31-2s�12 <br /> Phone: ��3-2.t�q-'Zc�►q"� office (cell) <br /> Mailing Address: }�o � '3�5 City:�.�,�o„o ZIP: j�_ <br /> Contact Person: ° Applicant is: �'fo"� / Homeowner (Circle One) <br /> Email and/or Fax: � 5� ,�� ���m n . C,�n-� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �m� <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �n-� <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 8� <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 i nnehahacreek.or <br /> Estimated Construction Valuation(excluding land) $ �Z,� <br /> . <br /> Last Updated: 4/26/2011 <br /> - 19- Srg <br /> "��j, <br />