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� ••�, <br /> . <br /> City of Orono <br /> Building Permit Application ��� j, � �( d�e <br /> for New Structures or Additions . <br /> Mailing Address: permit num r. �_f ��v[.r <br /> g,0,� PO Box 66 <br /> Q 0 Crystal Bay,MN 55323-0066 Date recei' d: ;�� <br /> a a, Street Address:' Received y: <br /> �'�c, „ �ti�' 2750 Kelley Parkway Plan revi fee: , '?� •,37 <br /> r��og� Orono, MN 55356 ���,� �����; <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 mu be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �$ LC�� S�reB.�' ��'oh 0 M� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes f�No <br /> ff yes,a specia/event permit is required with Police Department and City Council approval 60 days p rior to the event. Shuttle bus service wil/be <br /> required unless applicant demonstrates suficient on-site parking is availab/e. Non Permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �Id�� 4� era}�0 <br /> State License# �. Expiration Date: 3- 3�- 2 01L <br /> Phone: 9SZ• �I��'•2/A� (office) �e12•`$S �OOa►$ (cell) <br /> Mailing Address: 3`13 Gd�n IOl Cit : t'li •,t*k� ZIP: SS3`I <br /> Contact Person: �'i Applicant is: n rac o / Homeowner �c�►cie o�e► <br /> Email and/or Fax: �e��1 5oy�r �w'1 j�� . �s•�,� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �e•�. kaPaMK <br /> Phone(day): 9 Z, • .} y <br /> Address: 60 D; e. a, Cit : ZIP: 3 SG <br /> Email and/or Fax ay��►k� r' ..Gs <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Jt�� Tr�'�'C11 <br /> Phone(day): 4SL• L�0•ZOZ$ <br /> Address: ,Z3�3 D�i� Cit : � _ ZIP: " Sl7 <br /> Email and/or Fax: ��tr�_ '{.�,M t Si • Gerh <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> �New Construction f�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 8�permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Othe�:(SpeCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m innehahacreek.or <br /> Estimated Construction Valuation(excluding land) $ � �� <br /> Padcet Last Updated: 10-20-2011 <br /> -20- <br />