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� . � � � ���� � <br /> City of Orono j� � <br /> � � g�. <br /> Building Permit Applicatio <br /> for New Structures or Additions <br /> Mailing Address: Permit number: /�� �Q7� <br /> ���0 CrysBtal Bay, MN 55323-0066 Date received: �� •l <br /> StreetAddress:' Received by: T <br /> y ,�- 2750 Kelley Parkway Plan review fee: �Q . <br /> F �` Orono, MN 55356 <br /> �qkFSHo�`` Main: 952-259-4600 Total Fee: a�! ' ��� <br /> Fax: 952-249-4616 v��r�w c� oror��o mr� 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: 3��C� N �r U�} �2 R� �-- A-� � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a specia/event permit is required with Police Department and Ciry Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �� e. l �e _ <br /> State License# - C� Z� Expiration Date: <br /> Phone: cell ES 'ZZrJ 3 office (o �'Z?� 3 <br /> Mailing Address: � Z� t�V�pJ�2. � � City: a�v1 ZIP: �.S' ��{ <br /> Contact Person: �`M�:� Zµ�1�-- Applicant is: � / Homeowner (Circle One) <br /> Email and/or Fax: c_t� 8� � t^C �C�—Cx-1 J L� �`� <br /> PROPERTY OWNER INFORMATION: � � �� � �c <br /> Name: <br /> Phone (day): �S Z�1U <_ 1 -i <br /> Add ress: � 'b ZS � A ���`�R �� City: M�l..'l V1�1 ZI P: � �� �1{ <br /> Email and/or Fax C� '�c�j�C i� '�-C��G� , C�J i`n <br /> ARCHITECT/ENGINE�R IN�OR�MATI�N��. � � ,� <br /> Name: �— <br /> Phone (day): , Z 33l� 3 3 <br /> Address: Cit : ZIP: <br /> Email and/or Fax. j.,_ n� y 7 b � L A �rJo , �� �"� <br /> � <br /> PROJECT INFORMATION: Description of pro�ect: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� <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&permits. ❑ Industrial ❑ 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) $ � �''� dG�`� �''� <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />