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. ' <br /> � City of Orono <br /> Buitding Permit Application <br /> for New Structures or Additions � <br /> Mailing Address: Permit number. a��a-��6 3 ' . <br /> -�Q 7 � 3- � � <br /> O�" �O Cry sal Bay,MN 55323-0066 Date received: j � <br /> �. � � <br /> ���, ` Received by: <br /> ,.� ,, Street Address:' <br /> ,� 2750 Keliey Parkway Plan review fiee: o20�a"�� 3 � , <br /> ° Orono,MN 55356 lOD�v.(�j <br /> .!; y�� 6 <br /> \�$si�� �: r.. : <br /> Main: 952-249-A600 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 prinf) <br /> GENERAL INFORMATION: .�� <br /> Job Site Address: f ' <br /> Will this be a Parade of Homes, Remodeler Showcase Home or other Display Home? Yes No <br /> If yes,a specra!event permit is required with Police Department and City Council approva!60 days prior fo the event. Shuttfe bus service rll e <br /> requrreii un/ess applicant demonstrates suffrcient on-site parking is available. Non-permltted events will not be alfowed. <br /> CONTRACTOR!APPLICANT INFORMATION: <br /> i,v.c, <br /> Name: �L.. c.c�.� ','���°�`� �"�0'TM'r� Expiration Date 3f 3 i �� � <br /> State License# 'Z-O office "i(cr - 4 � "'►�� � cell <br /> Phone: , � Cit : ' ..�a� ZIP: S S 3� <br /> Mailing Address: 'T oo � , <br /> Contact Person: cr—.-- Applicant is: ontrac o / Homeowner (Circle One) <br /> � ZI <br /> Email and/or Fax: �, . � <br /> PROPERTY OWNER INFORM�+ATION: . : <br /> Name: <br /> Phone(day): Ci : ZIP: <br /> Address: � <br /> Email andlor Fax . . <br /> ARCHITECT/ENGINE�It��ORMATION: . <br /> Name: � <br /> Phone(day): Cit : ZIP: . <br /> Address: . <br /> Email andlor Fax: � _ <br /> PROJECT INFORMATION: � 4.Sewa e Dis osal& . <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 9 p ' <br /> Water Supply <br /> �;,Sin le Family with Residence � <br /> "�'New Construction 9 <br /> ❑Addition attached garage �Garage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck Private Sewer <br /> ❑Relocation detached garage ❑Office/Commercial ❑ <br /> ❑Other: (specify) ❑Multiple Family/Condo ❑Warehouse public Water <br /> ❑ Public ❑Storage � <br /> **Any earth movement may require ❑Commercial ❑Other(specify) . <br /> MCWD review&permits. ❑ <br /> Industrial ❑Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other:(specify) <br /> 1II202 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) $ �.,�,a"��w� 0� �� <br /> ��-,� d .3 �SS , �8 � .� <br /> -g:.;`��ie�-�'`- <br />