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C��(e� ��x.1.�ll�Z� w��� <br /> ,�- �P�,.��..., <br /> City of Orono � ` <br /> � Building Permit Application �/l �1/g, � <br /> - for New Structures or Additions <br /> � <br /> Mailing Address: Permit number: 070/y-GG 7 / <br /> .�Q A TO PO Box 66 <br /> `w Crystal Bay, MN 55323-0066 Date received: 7-07� -/ � <br /> StreetAddress:' Received by: �'"N <br /> � 2750 Kelley Parkway j�:��G�J. 3 <br /> y �` Plan review fee: � <br /> �' c,` Orono, MN 55356 <br /> `qKESH��� Main: 952-259-4600 �G�y -GG�'J(i <br /> 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: �S � i���i r-c L��t.� <br /> Will this be a Parade of Ho es, Remodelers Showcase Home or other Display Home? ❑ Yes [�-Pdo <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: UB v�y� �o,N,,c S <br /> State License# a�( � Expiration Date: <br /> Phone: cell (Q ( -"1 - office <br /> Mailing Address: /0:2 B So►� l�� Cit : � '�J ZIP. � <br /> Contact Person: ��-�� Applicant is: n racto / Ho eowner (CircleOne) <br /> Email and/or Fax: G�}-1,�ar,�� �ar..�a ea hovv�.,�s . �owl <br /> PFcGPERTY OWNER INFORMATION: <br /> Name: (��r�V-t0. ��e S <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: TO � CoNh e ��y <br /> Phone (day): �7�3-`!3�- N.SU`(/ <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & <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 ❑ Office/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 /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �O�Q B 9�/ <br /> Packet Last Updated.� 04/19/2013 <br /> Page 22 of 23 <br />