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. ,�' <br /> V `� I i�\\�-�.J <br /> City of Orono <br /> Building Permit Appiication <br /> for New Structures or Additions <br /> Mailing Address: � <br /> �,�,� PO Box 66 Permit number: �-�,�{�.. <br /> Q � O Crystal Bay, MN 55323-0066 Date received: �-�,-r'j-(,}9 <br /> I �, � <br /> 'a '� s, Streef Address:� <br /> Received by: �% ��'�'�i'�-� <br /> � ;�r� <br /> �'� ��� � 2750 Kelle Parkwa � . / � . ��� <br /> '�a � 'tiG Orono, MN 55356 Y � � CC' 9 Ptan review fee: <br /> 'kESFio4 <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 applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �'��4�} A,�„����� <br /> Will this be a Parade of Homes, Remodel re s Showcase Home or other Display Home? ❑ Yes � No <br /> If yes, a specia/event permit is required with Police Department and City Councif 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/APP ICANT�NFORMATIC�L; <br /> Name: � K�- �� <br /> State License# 2 Expiration Date: 3 3 <br /> Phone: � d�- � office cell <br /> Mailing Address: = Cit : �L:��uiS �ZIP: S��Z� <br /> Contact Person: ��v ���.}��,` Applicant is: ��ontraCtoJ / Homeowner (Circle One) <br /> Email and/or Fax: Ko��1.{���1�G2- ����L , C�o� <br /> PROPERTY OWN INFORMATION: ���� � �'j� a- �{ �� -J f !� <br /> Name: �;�/C;� �v}{►.�s� s <br /> Phone (day): - _ �p _ <br /> Address: _ 5�p � � K�'�;���t City: �,�,,� ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: 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 ❑ Res�ence <br /> ❑ Addition attached garage ��arage/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 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � (Z���j -- <br /> Last Updated: 6/22/2009 <br /> - 19 - <br /> � ' a:�� <br />