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� ''1`7 <br /> . �; �� � <br /> �. C�ty of Orono `����� � �'� <br /> ' • • ' ' tion � <br /> � Bu�iding Permit Appl�ca <br /> for New Structures or Additions ���-ao�8/ <br /> Mailing Address: Permit number: ��70� l� <br /> O�Q J�'O PO Box 66 �jeYl�K� <br /> �`r Crystal Bay,MN 55323-0066 Date received: d <br /> Street Address:' Received by: <br /> � �,� 2750 Kelley Parkway Plan review fee:� <br /> �0�,4• Orono, MN 55356 <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us `��' V <br /> This application form must be compieted in fuil and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: ��'�> <br /> Job Site Address: (�I� �t { iI"f l C:�� � '�z-% - <br /> Will this be a Parade of Homes, Remodele howcase Home or other D�splay Home? Yes No <br /> If yes,a specfal event pemiit is requirad with Police Depariment and City Councif approval 60 days prior to the everrt. Shuttle bus service will be <br /> repuired unless applicard demonstrates s�cient on�8e parking is available. Non-permitted events wi0 not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �C.�:KICC-NPCc, b���Pt-�t <br /> State License# Expiration Date: � i/ <br /> Phone: q S�- g8 - z7�.Z 5 (office} (��� -��S -�3�'� (���1 <br /> Mailing Address: y o/ CA 7 '� C� : vor� r+v rJ Z�P: S � Z <br /> Corrtact Person: � ,.�.- � Applicant is: n ra ' / Homeowner �c�ra.00.► <br /> Email and/or Fax: R��u ����kc'�-'P�� . C��^'� S� 8$�'2-259 <br /> PROPERTY OWNER INFORMATION: <br /> Name: TQ�17 FF n�c� �r"�� /�A 2�M A�S <br /> Phone(day): C'�,i 2- 518 - Z2�'// <br /> Address: �D /rlYrr-���.r��� 2c�� �ity: c�rZ��,.��Q Z1P: 5�39� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: Ciry: ZIP: <br /> Emaii andlor Fax: <br /> PROJECT INFORMATION: <br /> 1.Type ot Project 2.Proposed Use 3.Structure Type 4'��� Supply�'� <br /> ❑New Construction �Single Farrrity with �Re�dence <br /> ,�"Addition atbeched garage ❑Garage/Accessory Bldg. ❑Public Sewer <br /> ❑Accessory Building ❑ Sin�e Family with ❑Deck <br /> ❑Relocation detached garage ❑Office/Commeraal ❑Private Sewer <br /> ❑Oiher:(speaTy) ❑Multiple Family/Condo ❑Warehouse <br /> ❑Public ❑Storage ❑Public Water <br /> "Any earth movement may requlre ❑Commercial ❑Other(specify) <br /> MCWD review b permlts. ❑Ind�trial ❑Private Well <br /> Minnehaha Creek VYatershed Distric�(MCWD) ❑Other.(specify) <br /> 18202 Minnetonka Bhrd <br /> Deephaven,MN 55381 <br /> Phone: 952-471-0590 <br /> Fax: 952a171-0682 <br /> www.minnehahacreek. <br /> Estimated Construction Valuation(excluding land) S / Z U C9�? <br /> Last Updated: 9/23/2009 <br /> -17- <br />