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� � f <br /> City of Orono � <br /> ; �� �l�-� <br /> Building Permit Application <br /> for New Structures or Additions <br /> �--� <br /> Mailing Address: Permit number: ���— ����� <br /> j�,0,�.� PO Box 66 �y <br /> � � .�: 04 <br /> Crystal Bay, MN 55323-0066 Date received: /�O/ �� <br /> I� ��� <br /> �I,a � z� ;�_` a,l, StreetAddress:' Received by: <br /> ��' � �� ti�'/ 2750 Kelle Parkwa � <br /> \ �,�aE � Y Y Plan review fee: � a 7✓- � <br /> � «`r g� Orono, MN 55356 <br /> �;ESH�. d l� —DO <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 apptications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: /l��(� i CL�� �2 � �`j�,��(/� <br /> Will this be a Parade of 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. Shutfle bus service wil!be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLI ANT I FORMATION: <br /> Name: C,� �^ -lC �O �i u�rJ/� <br /> State License# ��/3 p j y y Expiration Date: z- Zcr <br /> Phone: . " �;�- j7 office %Z- Z�L-- 7t/ cell <br /> Mailing Address: � �c ' E ,�/1 Cit : ' �{�; �,/ ZIP: 3i'7 <br /> Co�ta�t Person: Applicant is: o tracto�' / Homeowner (Circle One) <br /> Email and/or Fax: 'j ,ja., � - ,,,� � �o„� , �� <br /> PROPERTY OWNER�IJNFORMAT N• <br /> Naiile: 1�1: (� �f.C2��LL <br /> rhone(day): � <br /> Address: IIb 0 i lL STd,�J � Cit : Q��� ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGIN R INFORMATION: <br /> Name: _ �k'�E S�C�`/,��`Tj" d- �Sc�C e%FTEs <br /> Phone(day): ___lj�-- �,�,.-jo ZZZ <br /> Address: 3Z� ,ti1,4�,i�f��4 ' F 5• CitY: ��]-�2,//�T`�'f ZIP: s��f <br /> Email and/or Fax: y,SZ- �/�7'� -- (�n <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 <br /> ❑ Other: s eci �Private Sewer <br /> ( p fy) ❑ 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 �1 <br /> Phone: 952-471-0590 �- ��/'�� <br /> Fax: 952-471-0682 ��+���/ <br /> www.minnehahacreek.or ��� <br /> Estimated Construction Valuation (excluding land) $ � dQQ , o�; <br />