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Co�(e� �fi�.l,�l�vZ� wl� <br /> ,5lt�o�t �Piu�L�v�+-�.� <br /> City of Orono <br /> Building Permit Application � �1/g, � <br /> � � . <br /> , for New Structures or Additions <br /> Mailing Address: � <br /> �T PO Box 66 Permit number: 0�0/y—OD 7 <br /> �'�`VD Crystal Bay,MN 55323-0066 Date received: 7-07� 'f � <br /> Street Addr�ss:' Received by: � <br /> � ,,� 2750 Kelley Parkway Plan review fee: a�U�/. 3 <br /> y�' c, Orono, MN 55356 <br /> ��kESHO��' Main: 952-259-4600 Total Fee: °?D/`�-00770 <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: �� �C i r��-��r-c LavL� <br /> Will this be a Parade of Ho es, Remodelers Showcase Home or other Display Home? ❑ Yes [�]-b'o <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: Ge v�y c_a� H-o w�.� <br /> State License# a Expiration Date: <br /> Phone: cell ( -'1 office <br /> Mailing Address: /D 2 B i v. Mt Cit : '�f ZIP: ' <br /> Contact Person: E'fi�h Applicant is: racta / Ho eowner (Clrcle One) <br /> Email and/or Fax: G�}-1,�a��v�n.0 eA �vv�,�s . �oN7 <br /> PFcOPERTY OWNER INFORMATION: <br /> Name: �hy.�.0. �o v��e C <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: TO v` �ohhe ��V <br /> Phone (day): �7L 3-y3�- 45U'� <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro'ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8 <br /> Water Supply <br /> New Construction Single Family with esidence <br /> ❑Addition attached garage ❑Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑O�ce/Commercial rivate 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 rivate Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (Specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> f ax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 6�� 6 6�/ <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />