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: � -�(510� <br /> � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> —� Mailing Address: p�,� <br /> /���,0,�.\ PO Box 66 Permit number: �Q_ So <br /> � � Crystal Bay, MN 55323-0066 Date received: S��-49 <br /> ,, O � O v�� <br /> �� �� � �I Received by: � <br /> ��a ,j.t�-_�',. �.�; StreetAddress:' <br /> \'$'�,t�'.��Y���Gti� 2750 Kelley Parkway Plan review fee: q'lo��.J'�'� <br /> � � Orono, MN 55356 <br /> ESHO aeo9-ooa6.� <br /> _--' Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: /Z�',� Lom9 �I,�IB �j/� (]/ZUlt177 /iyjh� c��G y <br /> Will this be a Parade Qf Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service ill be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: jl ����/� <br /> State License# Expiration Date: <br /> Phone: 9��- �/ - Z(o (office) (cell) <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: Applicant is: Contractor / omeowne (Circle One) <br /> Email and/or Fax: /��jj��� ��y�� �e' �(`��,�� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �����_ �i/g���� <br /> Phone (day): 9$�Z- �/�2 — OZ�_ <br /> Address: �Z 9S �j,J?g �!/�,f�,�� City: ���9)f�f) ZIP: SS��iC� <br /> Email and/or Fax �f���i� � /,Q�2��p, �,.n — JGLl�„P�/�� �1��r,�p�L•(.ey�, <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <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 Garaae/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) ❑ 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) $ �, Q� <br /> - 18 - <br />