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� . � � �-� Cit of Orono �'
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<br /> � �� h �� Building Permit Application
<br /> `t for New Structures or Additions
<br /> ---:� Mailing Address: Permit number: a p/ o�� �/a �
<br /> g,0,�. PO Box 66
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<br /> Crystal Bay, MN 55323-0066 Date received: 1� -��7 -/ �---
<br /> �'""'�"°° Received b
<br /> �a ''�"�( ,- _ a� StreetAddress:' y�
<br /> '� y�� ��``' 2750 Kelley Parkway Plan review fee: � 3• �
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<br /> Orono, MN 55356
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<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. Z z;2
<br /> Incomplete applications will be returned. (Please print) �%/�2
<br /> GENERAL INFORMATION:
<br /> Job Site Address: 2��0 IvO�'�h S �t-o� �'L�
<br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No
<br /> If yes, a special event permit is required with Police Department and City 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=peTmitted events will not be allowed.
<br /> CONTRACTOR/APPLICANT INFORMATION: '�� ���Yl '.'�+�L ��� l f C��7
<br /> Name: :Si cJ�.� Lv��,i3���
<br /> State License# ts}�Z � Expiration Date: �3 - 3 j- j�
<br /> Phone: Cj�'�^ tj��-- �E;E:�, (office) y.S'"Z- Z-yC1- Y// � (cell)
<br /> Mailing Address: ��5� (/,¢�Ly �/,�c=�J l�,��. City: _/�%,2�.,g-,c/ ZIP: �`_S 3_S Z
<br /> Contact Person: ,i'gfJi,r� �,�/wc�C" Applicant is: Contractor / Homeowner (Cirde One)
<br /> Email and/or Fax: ,�,g-�,�=,� ,�/'�,,>�,�L v�l�3c;�, c,c,� ,�,g� �i S Z - �`f O �� 7(0
<br /> PROPERTY OWNER INFORMATION: '
<br /> Name: f�C�='� /�U�,�F�'
<br /> Phone (day): � / Z . c'% ' � G -
<br /> Address: Z� yb � C.��- i�v.��� 'i�,��Jc c�ty: �,��v�1�G ZIP:
<br /> Email and/or Fax ���ti;- � �rt E�N v p,��",-�. Ccv�
<br /> ARCHITECT/ENGINEER INFORMATION:
<br /> Name: �/�'I/'�E� ,��/�� ��.9-�i/�cs $ ��-=5/CG-/✓
<br /> Phone (day): �s'L-- 7y/.; - 7 70�-
<br /> Address: lGc% `$Cir%Th' l=G'�-�-�=/�� .5%����T��yla City: _S�'�K�%���� ZIP: S S � 7�
<br /> Email and/or Fax: ;'yi�G��l'���H��v,�,�,-i;,c,r-:�r�n v,�s���' .�'/-�X �".���� 7'��v -- i io�
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<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 ❑ 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 5�v.��C-�,�..S��G�
<br /> Deephaven, MN 55391
<br /> Phone: 952-471-0590
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<br /> Fax: 952-471-0682 �:'
<br /> www.minnehahacreek.or -
<br /> Estimated Construction Valuation (excluding land) $ ���� �
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