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� 4 <br /> � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: ��!��/ �a <br /> �A,. PO Box 66 <br /> � l v� Crystal Bay, MN 55323-0066 Date received: / 2-!Z -/� <br /> StreefAddress:' ' ed b : <br /> y � 2750 Kelley Parkwa Plan review fee: <br /> �' c.� Orono, MN 55356 ����� '7 L � �� ° 7S d • � <br /> �qKFSHo�`` Main: 952-259-4600 Total Fee: <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: �NT ti <br /> Will this be a Parade of Homes, Remodelers 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 ill e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ,l��-r�,.� �o25f.NIE.D � ouTMv���./ �s�s►.1 <br /> State License# N//� Expiration Date: <br /> Phone: (cell) (a�L�q2?- � isq (office) (Lsi� Zo�- 30�� <br /> Mailing Address: a; � Cit : ST, l�nu� ZIP: S--i o <br /> Contact Person: `/„�r�.� Do�cScM�E�7 Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: ;�)o��c4�;ed�.s���,✓;P oc` ��arr, <br /> PROPERTY OWNER INFORMATION: <br /> Name: o,.,� <br /> Phone (day): 3 3 - ¢So 0 <br /> Address: CR I v2 dLSo,� IUI�F.�nc�t� I-(��y City: �oc,��,,., U�.���y ZIP: ��4 ZZ <br /> Email and/or Fax _ ��,���a„�_�e��,,,��,��pc.r�n„n <br /> .."� <br /> ARCHITECT /ENGINEER INFORMATION: <br /> Name: ('iU,� b�c�c�J �eo��SttoriJ�ac�S <br /> Phone (day): _ f�z� 3a 3 - S3 i� <br /> Address: ��q G-,yN��-r,E /��E S S-r� 70o CitY��c,G6M�AJCTU� ZIP� SS4Zo <br /> Email andJor Fax: S�-e�e��,c.d� -u S•C.oM <br /> PROJECT INFORMATION: Description of project: <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) QFY ,��4 W,a�� ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may require ❑ Commercial �[Other(specify) <br /> MCWD review& permits. ❑ Industrial e�Y4,..,i,��,����r,�5 ❑ 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) � �1 0�o <br /> � <br /> Packet Last Updated.• April 2014. <br /> Page 17 of 19 <br />