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� ' ' �E�EIVED <br /> �o� City of Orono SEP 2 4 2009 <br /> ��� Buildin Permit A lication ��-�rY caF oRot�n <br /> J pp <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �(� — d 1 <br /> �,0,j� PO Box 66 <br /> O O 1 Crystal Bay, MN 55323-0066 Date received: � � <br /> � � <br /> ,� � '��� �� Received by: <br /> ' .��,� �, ; StreetAddress:' <br /> '$'�,c, '��::0_ �ti� 2750 Kelfey Parkway Plan review fee: , <br /> '�� �� F��4� Orono, MN 55356 aQ _ ,;� � <br /> kE5H� <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. (Please prrnt) <br /> GENERAL INFORMATION: <br /> Job Site Address: �_�/�g L yric �-,r e <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [�No <br /> If yes, a specia/event permit rs required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates suffcient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �I��.,P �«�r��,F <br /> State License# � o.v o Z 2�� Expiration Date: <br /> Phone: z - -6 2 S� office cell <br /> Mailing Address: y 1h S Cit : �, �, ZIP: S — z <br /> Contact Person: Applicant is: ontrac / Homeowner (Circle One) <br /> Email and/or Fax: ,�i S�( _ ,,� y�,G ,`o„ �g �j G,/hR,'f..Go�1 <br /> PROPERTY OWNER INFORMAT4ON: <br /> Name: �o i 5 ��,d�e c� <br /> Phone (day): <br /> Address: �Ll�g L�,y;G �,�, City: (jro.�cu ZIP: �S ��i / <br /> Email and/or Fax <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 & <br /> Water Supply <br /> ❑ New Construction ❑ 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&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 Vafuation (excluding land) $ � SOU <br /> Last Updated: 6/22/2009 <br /> - 19 - <br />