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• � � ��, � �b��� <br /> �� , <br /> � <br /> --�,�' '�' <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �D� - b��� <br /> Qv�,� PO Box 66 <br /> � � � Crystal Bay, MN 55323-0066 Date received: � -j- � � <br /> ��`��'�'�"' Received by: <br /> a �7 :�` s. Street Address' <br /> �' �� '� '�`�� ti 2750 Kelle Parkwa � <br /> � p Y Y Plan review�e: <br /> L9kESHOg� Orono, MN 55356 g�� <br /> - Total Fee:}�U j ,����j� <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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: Q/ � � % , ,� �� �C�v2 �-l�t lL—� <br /> Will this be a Parade of Homes, Remodelers Showcase Ho e or other Display Home? ❑ Yes o <br /> lf yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service w�ll be <br /> required unless applicant demonstrates su/ficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �i Pr t3tVl �'r�. Of /�.�n� <br /> State License# � Expiration Date: '�--3/ -/Z. <br /> Phone: �� �,.- ��[c (office) (o/Z- '7C?3- �S`3/ (cell) <br /> Mailing Address: ��g�� /��� ��� ^/ City:� !rf �/a/fLh ZIP: 5,5's�Z7 <br /> Contact Person: gC V/J� �/f-p� Applicant is: oniractor' / Ho eowner (CircleOne) <br /> Email and/or Fax: hc V��h r= Gi%G�'f3Cr� O . GD� <br /> PROPERTY OWNER INFORMATION: /� <br /> Name: ,/��Q �CI`; �h C..Q,rr�,p <br /> Phone(day): 2/ - "8- z ' <br /> Address: p Cit : �/CG ZIP: ,s$",�� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: Cit : 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 I / detached garage ❑Office/Commercial ❑ Private Sewer <br /> �Other:(specify) [�l+�l,G1 �G� ❑Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may require ❑Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial <br /> ❑ 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 Valuation(excluding land) $ �� ` <br /> Last Updated: 12/21/2010 <br /> - 19- <br />