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City of Orono �� � <br /> � <br /> Buildin Permit A plication � �� ��� <br /> J p � <br /> for New Structures or Additions <br /> Mailing Address: Permit number. 02 p�3-0�07fo <br /> �Q�O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: I -I�' �3 <br /> StreetAddress:' Received by: �� <br /> -� 2750 Kelley Parkway � � , <br /> y �" Plan review fee: <br /> �' c,` Orono, MN 55356 � <br /> `qkESHO�� Main: 952-259-4600 Total Fee: a�) � <br /> 1 <br /> Fax: 952-249-4616 �v�nnr�.�i_orono_m;��.us C.t �4�` ' ,j`;`J'� �)� d _: .. ��� <br /> This application form must be completed in full ai�d all required information ust be submitted. <br /> Incomplete applications wiil be returned. (Please print) <br /> GENERAL INFORMATION: 1 <br /> Job Site Address: ; �..�...5 oYl oa-d <br /> Will this be a Parade of Homes, Remodelers Showcase ome or other Display Home? ❑ Yes No <br /> If yes, a special event permit is required with Police Department and City Council approva!60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICAN INFORMATIO �,.. <br /> Name: �'o �o`�'er e.,o►�,5�t' �orl �.rl.0� <br /> State License# Q C, 13 0 l Expiration Date: 3 -3 -a.0) <br /> Phone: cell � -� office 9 5 a,-''�-'1 O-9$'1 <br /> Mailing Address: �� 1 v 5 ��t� r i Cit : ZIP: S � � <br /> Contact Person: o o er Applicant is: Contract r / Homeowner (Circle One) <br /> Email and/or Fax: o r o r i ort• o <br /> PROPERTY OWNE�FC�RMQrAT�ION�.� � �� �` <br /> Name: od r q., rW�„ �., <br /> Phone (day): �� - � <br /> Address: o ` ', p o Cit : Q ro1'LO Z�P= S� � � <br /> Email and/or Fax 0. . C,o <br /> ARCHITECT/ ENGINE��N�FORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION; Description of project: <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 8�permits. ❑ Industrial � Private Well <br /> Minnehaha Creek Watershed District(MCWD) � Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 I 1 <br /> Phone: 952-471-0590 ��0.C�t�d �C�T'C�Q�, <br /> Fax: 952-471-0682 l <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � � _O 00 .00 <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />