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. _ �� �� <br /> ity of Orono -Z,o� <br /> � �� � <br /> Building Pe pplication <br /> for Ne uctures or 'tions <br /> Ma�ling Addness: Permit number: O ��g � <br /> �O A TO PO Box 66 _ <br /> f w Crystal Bay, MN 55323-0066 Date received: �'/ <br /> StreetAddress:' Received by: <br /> y 2750 Kelley Parkway Plan review fee: <br /> e� ��� Orono, MN 55356 <br /> �'�kFSHo�`` Main: 952-259-4600 Total Fee: <br /> 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: ��0 Il��'t� �},.� �r-IvP <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> If yes,a special event pe►mit is required with Police Department and City Counal approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sutFicient on-site parking is available. Non pem►itted events will not be allowed. <br /> CONTRACTOR!APPLICANT INFO MATION: <br /> Name: �Q.�at r--��� �-� �� ^ L�►�.��r�-�1-er s �,..�. <br /> State License# Expiration Date: <br /> Phone: (cell) fa�Z-�(i o-- �l I I (o��) <br /> Mailing Address: 3 " c- Ci : ' n ' ZIP: 5��6 <br /> Contact Person: Sw.-.-�-e. Applicant is: ontractor Homeowner �ci�ie o�e� <br /> Email and/or Fax: v,1� ��r C L�.-#�w.��( cb..-� <br /> PROPERTY OWNER INFORMATION: <br /> Name: '�,r� �,���(,� <br /> Phone(day): ��2--�'-��3• �.s'o <br /> Address: �i ' N �'M C� � a��� Z�P� �� <br /> Email and/or Fax �,rbL��(( � -I-1`er}�P f aP 1� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion 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. 0 Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation � detached garage ❑Office/Commercial ❑ Private Sewer <br /> �'Other: (specify) �1Z�cn� ❑ 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 Dist�ct(MCWD) ❑ Othe�: (Specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minneh ha ek. <br /> Estimated Construction Valuation (excluding land) $ ��164� <br /> Padcet Last Updated: 04119/2013 <br /> Page 22 of 23 <br />