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� s�' <br /> � � 2a,�3 <br /> . � <br /> . �J� � <br /> city of orono '7 �J� <br /> Building Permit Application � <br /> for New Structures or Additions <br /> MailingAddress: �� ` <br /> �O A,O PO Box 66 Permit number: <br /> �� Crystal Bay, MN 55323-0066 Date received: 7'.',.��/.,3 <br /> Street Address:' Rec�eived by: <br /> y ,� 2750 Kelley Parkway Plan review fee: �3 .� <br /> �' c? Orono, MN 55356 <br /> t�K6SH0�`� Main: 952-259�600 -�p��F�; � �•3 �737 <br /> Fax: 952-249-4616 www.ci.orono.mn.us �<<� <br /> This application form must be completed in fuU=.and all required information mu t be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: _'���_� � �.� g,�u� , �-p W�N �S�ar J <br /> Will this be a Parade of Homes, Remodelers owcase Home or other Di play Home? ❑Yes 0 No <br /> lf yes,a special event permit is required with Police Department and City Counci/approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufflcient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �'-S��C--x,.y e� ��.[_ aV�i�l �`�--'�l�l <br /> State License# ?�5�43t� Expiration Date: <br /> Phone: (celq 6�2_ 261 ��1 p (office) <br /> Mailing Address: �"►�—� � ,ti��� ���. City:M�lnn.;�.f��v.S ZIP: 5��.�� <br /> Contact Person: �� Ly�p�„� Applicant i • / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �� ��_ <br /> Phone(day): fo�tn <br /> Address: �C� �l s� ��. City: j7;��� ZIP: ��`�( <br /> Email and/or Fax �t�c�w�����g�,,wwr�„c�,n,� ' <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro'ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ?�-New Construction �}Single Family with �'Residence <br /> ��]Addi6on 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 requlre ❑�ommercial ❑Other(specify) <br /> MCWD review&permits. ❑ 4ndustrial ❑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.m innehahacreek.o <br /> Estimated Construction Valuation (excluding land) $ 2� �� � <br /> T � <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />