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� . . City of Orono . . � � � � <br /> Buildin Permit A lica ion �" <br /> J pp t I � <br /> for New Structures or Additions �J2�a � <br /> Mailing Address: �D�a-U�-� g 7 <br /> O�D,�O PO Box 66 Permit number: <br /> Crystal Bay, MN 55323-0066 Date received: 0 -� 3-� <br /> �`�''�'�'° Received b � <br /> �„a '�'� �, � StreetAddress:' y� <br /> � y�� ���' 2750 Kelley Parkway Plan review fee: � ,?� <br /> � � "� '� Orono, MN 55356 ��/a _�-� �� <br /> \t� og'/ <br /> ��ESH,� <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: ;[�j j ,�� ��y �{� <br /> Will this be a Parade of Homes, Remodel rs Showcase Home or other Display Home? ❑ Yes ❑ No <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 /> CONTRACTOR/APPLICANT INFORMATION: / <br /> Name: 1�Ccr l ��t�' lv�5���-cCh�� <br /> State License# [j�/�3�'g(� � Expiration Date: 3-3 y I�/ <br /> Phone: (���- �J�1�t��b' (office) (cell) <br /> Mailing Address: �y� /�/�a��, J.�,.Q �l/ City: %�i�;,�_ ZIP: S'�'yy� <br /> Contact Person: ��,-, �a��5,,,,,, Applicant is: Contr ctor / Homeowner (Circle One) <br /> Email and/or Fax: �.��,,G}�Q/f,q�fS4-�"/.�i.tC�is����^� � <br /> PROPERTY OWNER INFORMATION: <br /> Name: /�a[�-, /��ut�.��r, <br /> Phone (day): - 1/� - �3 <br /> Address: 5 � � �n Cit : ,`o ;� ZIP: 3 <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P: <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&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) $ �,��,� <br />