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, <br /> r <br /> a�r . r <br /> • . <br /> City of Orono �� <br /> Buildin Permit A lication ���� <br /> 9 pp i <br /> for New Structures or Additions <br /> Mailing Address: Permit number: 3�,..� <br /> Q PO Box 66 <br /> � �� Crystal Bay, MN 55323-0066 Date received: o' �� <br /> StreetAddress:' Received by: /7/j <br /> y ,�- 2750 Kelley Parkway Plan review fee: �� <br /> �` Orono, MN 55356 a T ' (�3 <br /> F�qkESHO�� Main: 952-259-4600 Total Fee: dd` —�'��r <br /> 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: �� � �,��-�/y�� Z t�v�� <br /> Will this be a Parade of Homes, Remodelers howcase 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 /> ►vame: G c� 1-�e��,�•i <br /> State License# — Expiration Date: <br /> Phone: cell i a - -z �� 1 — `�D�� office <br /> Mailing Address: � c (Y1,�v�o «t� Ftw Cit : � , �v V� (ZIP: 5 � <br /> Contact Person: ���� k;� ��t V� Applica t is: ntractor / Homeo�(ier (Circle One) <br /> Email and/or Fax: ��}-�,� p� ��y rA F�ov►1�S . c��v� <br /> PROPERTY OWNER INFORMATtON: <br /> Name: �-b n v�e� E�o �w� � <br /> Phone (day): --` <br /> Address: ZI P: <br /> Email and/or Fax ,� � � <br /> , ' . L� u'(.� <br /> � � <br /> � � � � <br /> � ' `� `� ,Q� ZIP: <br /> /� �' ��v <br /> E V - �"" �� <br /> �C/ ' � <br /> F ��� �(��� C�� <br /> j_ `�� �y''" <br /> 1 � �e � � � vage Disposal 8� <br /> � � �� ter Supply <br /> C� Fai � <br /> [ ied � , 'A�.� � ;Sewer <br /> C Fam `1�1���� �� ► <br /> [ �ed ga V�/�` (� �Private Sewer <br /> [ � Fami� �� <br /> ❑ Public Water <br /> ""i �rcial ,..Necify) <br /> Mc al �Private Well <br /> Mir _, � viner. �specify) <br /> 18�.,� .������ewnKa tilvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �i �%�� <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />