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� � . . . . . . . . ,,. ...�. .. <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: !/[J — <br /> �,�,�. , PO Box 66 <br /> (,/O �,,, Crystal Bay, MN 55323-0066 Date received: 2 � <br /> i' �,`� �' Received by: <br /> '�,� �_;y �,�i Street Address:� <br /> �'S',F, + �ti� 2750 Kelley Parkway Plan review fee: <br /> � �� �� Orono, MN 55356 <br /> `�xEsso4`' i <br /> I 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: �,1 � �„/�� <br /> Job Site Address: `� �7,C-� ,�(c�+�"� �� ��1 ��. �'��C`'G' •�'�'�, '�✓� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes .� No <br /> If yes, a special event permit rs required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking rs avarlable. Non-permitted events will not be allowed. <br /> CONTRACTOR 1 APPLICANT INFORMATION: ---. <br /> Name: .;��-�-�.?.�~e ,.�j���p r1 �q �- C�o t'�,�� �"�'"C_,. <br /> State License# Expiration Date: <br /> Phone: (�'i �� � � �.� �office) (cell) <br /> Mailing Address: � City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: � <br /> Name: " .L Y'� � J- Gt/1�f GC�t'i � <br /> Phone (day): 95'� �- �o � /27') �r�G'"'/ <br /> Address: � �j,� P�` , �-Q„W� , �'7 � City: �'1��Cu,n.� ZIP: � <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: /� <br /> Name: S ��--e � ��«� � "� �- w f�I"CI IJ5 -+� 1` <br /> Phone (day)� t,� � Z �i �-��J �..�q�( <br /> Address: City: (�' ,��� �� <br /> Email and/or Fax: I�`� <br /> c� �� -�� <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use " � �r � il 8 <br /> � ' <br /> ❑ New Construction ❑ Single F ��`t�'�� � I <br /> ❑ Addition attache � �UQ� t r�~� �ssory Bldg. �Public Sewer �I <br /> ❑ Accessory Building ❑ Single F <br /> ❑ Relocation detachE ��i,,�,� �� rcial ❑ Private Sewer �, <br /> ❑ Other: (specify) �ti. �}t. ❑ Multiple f � �� ! <br /> ❑ Public ll ❑ Public Water � <br /> **Any earth movement may require ` ❑ Commerc (t�� � � <br /> MCWD review& permits. ❑ Industrial pl��o �75� ❑ Private Well <br /> Minnehaha Creek Watershed Distnct(MCWD) ❑ Other: (sp �rA.�,t.s <br /> 18202 Minnetonka Blvd i <br /> Deephaven, MN 55391 � <br /> I Phone: 952-471-0590 i <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq � ! <br /> Estimated Construction Valuation (excluding land) $ �l , pQ(� �- <br /> Last Updated 6l22/2009 <br /> - 19 - <br />