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(�o�'��� <br /> City of Orono �' y <br /> Building Permit Application � 5-'�.�� <br /> for New Structures or Additions <br /> Mailing Address: Permit number. 0���`-' B 4 js <br /> �,�T PO Box 66 <br /> � �v� Crystal Bay, MN 55323-0066 Date received: a�/R �—/� ' <br /> StreetAddress:' Received by: l�� <br /> 2750 Kelley Paricway Plan review fee: �p/,,�—�f�/,�fo <br /> y�`qkESHo�``G,� Main�.�952 2 9-4600 6 ' �y-Zb <br /> Total Fee: � '' <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> T�tis�pp�ic�tum for�r��st be�r�tpieted in f�ll a�at��9[r�qttireci inforrnatian rnt�st}�e subrnitt�d.' <br /> �ncomplete aip�[�ca#ions wiJi 1�retumatl. (Please print) ��� ` }�Z� <br /> GENERAL INFORMATION: r � � -;/ <br /> Job Site Address: �5 �eQ� S'� t, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> li yes,a special everrt permit is►equired with Police Department and City Council apprdval 60 days p�ar to the event. Shuttle bus service will be <br /> required unless applicarrt demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INE�RM T N: <br /> Name: V l5� :1� �. ���� <br /> State License# D 9$ Expi ation Date: <br /> Phone: cell 2 fo$�- ao � office S2� y7S- ?.o� <br /> Mailing Address: 3 �c� Cit : i'h N N Klc.� ZIP: -�"-�53 V S <br /> Contact Person: ��HH Q,.�,,. Applicant is: rac� / Homeowner �c�.��o�e� <br /> Email and/or Fax: ;o�h �j�r �,� ,�C�w- <br /> �- • ✓ <br /> PROPERTY OWNER INFORMATION: <br /> Name: Sc�S oa � �Na-1� <br /> Phone(day): 5 z• y <br /> Address: '�S I.e S4r-t�" City: �✓�tD ZIP• �'�' <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: Cit : 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 Disposal8� <br /> ❑ New Construction Water Supply <br /> ❑ Single Family with Residence <br /> ❑Addition attached garage Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation 1 � detached garage ❑ Office/Commercial ❑ Private Sewer <br /> j�'Other: (specify) p�SeN1�(�-�v) ❑ 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) ❑ 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) � � �"`j� � <br /> i <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />