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Ci f � � <br /> 0 <br /> ty o Orono � <br /> , - � Buiiding Permit App[ication <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �Ug- �� <br /> �� PO Box 66 � � � <br /> j Q O`,, Crystal Bay, MN 55323-0066 Date received: <br /> � �=`�"' I�' 'i Received b <br /> �,� �' �,� Sfreet Address:' y� ���� <br /> � <br /> �'s',�c, � "`�� ��/ 2750 Keliey Parkway Plan review fee: ��GG�.�. � — Q%' <br /> t � � OronO, MN 55356 �Sar <br /> '�kEsxo4`' � <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �� �lj <br /> This applicatio� form must be completed in full and all required information must be submitted. <br /> fncomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: _ /� /� <br /> Job Site Address: Ca� /V vz�N ��t� 17,-Z, �� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a specral event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service wil!be <br /> required unless applicant demonstrates su�cient on-site parking rs avai/able. Non-penrrrtted events will not be allowed. <br /> CONTRACTOR/APPLICANT INF�RMATIOy,� <br /> Name: J�-L C�IG1�L-�.✓��.- /5�.c�t.�c��s ��.c. <br /> State License# i��t fi Expiration Date: ,��. 2oio <br /> Phone: �jS2. g��-2z2S (office) (cell) <br /> Mailing Address: c�/ �,�,-_ �8�" S,—_ Cit : 73i,�s—��v ZtP: Ssy2c� <br /> Contact Person: TsH,,�- Q�,,NGg 4,� cr-n+ Applicant is: ontractor / Homeowner (CircfeOne) <br /> Email and/or Fax: ��s�^'S6'�^' <br /> PROPERTY OWNER INFORMATION: <br /> Name: ����-�- t S1Hn 2�+�-^- (�/.�,-.So.r� <br /> Phone (day): 9�Z- 4f"�2 - �-�3 <br /> Address: Cr� 8'J �.2zrc A,�,,,t ,z,s d' City: �i�r,�v 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 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 Q Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> �Other. (specify) �6'3��� �r ❑ Multiple Family/Condo ❑Warehouse <br /> �2�N- �-a���C ❑ Public ❑ Storage ❑ Public Water <br /> ""Any earth movement may require ❑ Commercial �Other(specify) <br /> MCWD review& permits. ❑ Industrial F'v�r+ � Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other. (specify) I <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 � <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 I <br /> www.minnehahacreek.or I <br /> Estimated Construction Valuation (excluding land) $ 3 � �O.o� <br /> Last Updated: 6l22/2009 <br /> - 19 - <br />