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. ' �- ��7��� <br /> . . ��. �� 3 <br /> City of Orono • <br /> Building Permit Appiication <br /> for New Structures or Additions <br /> Mailing Addr�sss: Permit number. ',�(,'1 � �q <br /> O���O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> St�et Atldress:' Reoeived by: <br /> 2750 Kelley ParkwaY Plan review fee: � <br /> 'rv���,�� 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 must be submitted. <br /> Incomplete appl�attons will be retumed. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: Z.3rj0 �.D1-IC�V I��J ��'�GL� <br /> WII this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> y y�ea,a s�ai e�renr pem►rr�s reqo�red wru►Par�e oepertmer�and crry ca,ndr e,�rove�so days�ror ro a►e e►�enr. snua+e aus seNke wia ne <br /> requirod unbss applica►►t dettAa►sdates suA7cient ars�e pe►kir►g!s avepeble. Non-pe►milted e�w10 not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ��f Z �U 1 I���KS <br /> State License# �'��� � Expiration Date: 12 <br /> Phone: (o�2-22 - 29�3 (office) (cell) <br /> Mailing Address: 00 C��S (�w A�� C' : N� L�P�I� ZIP: <br /> Contact Person: 'P� TZ Applicant is: on ractor / Homeowner �c�a a»� <br /> Email and/or Fax: � �D (? �,�a , Co n-� <br /> PROPERTY OWNER INFORMATION: <br /> Name: TD�1 �.`)A�ti( <br /> Phone(day): �2,._ '1_�-�� <br /> Address: 2'�,5� VI W GI'�GL� C' : 1�1� ZIP: <br /> Email and/or Fax �n ,r� D i - " " - "' <br /> � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: CSD �STI.I U N — �G� `��S I C�i� <br /> Phone(day): _ -3� ,t <br /> Address: . '�. Ci : ���, ZIP: SS�-t-��-- <br /> Email and/or Fax: d " <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Waber Supply <br /> ❑New Construction �Single Family with ❑Residence <br /> ❑Addition atteched garage �Garage/Acoessory Bldg. ❑Public Sewer <br /> �Acxessory Building ❑ Single Family with ❑Dedc <br /> ❑Relocation detached garage ❑Offioe/Commercial �Private Sewer <br /> ❑Other.(speafy) ❑Multiple Family/Condo ❑Warehouse <br /> ❑Public ❑Storage ❑Public Water <br /> *'Any ea�th movement may r+equire ❑Commercial ❑Other(specify) <br /> MCWD rsview�permits. ❑Industrial „�Private Well <br /> Minnehaha Creek Waterst�ed Distrid(MCWD) ❑Other:(sPepfY) <br /> 18202 NYnnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952�71-0590 <br /> Fax: 952�71-0682 <br /> . i <br /> Estimated Constniction Valuation(excluding land) ; O� <br /> Last Updated: 4/26l2011 <br /> - 19- <br />