Laserfiche WebLink
��--(�� �c�.� I��-- <br /> �zd C,�-U�.c�d=,1, <br /> J <br /> ��C�i�-Q-c1 <..�_.�; <br /> , �:�.�uJ�� City of Orono <br /> � �� <br /> `�'. : -��.�t;ylv��� <br /> y �--�L� �, ' Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number. � G <br /> �O,j�. PO Box 66 ` <br /> Q �' � Crystal Bay, MN 55323-0066 Date received: <br /> �e�.:z;. � StreetAddress:' c.Y''�S �' �� Received by: � CL <br /> �, � � 2750 Kelley Parkway �C�.a.z c+ C� z i �c�0 . �� � <br /> Ptan reriewn fee: <br /> '�g�Koq�$G Orono, MN 55356 <br /> ��-_-� Total Fee: <br /> Main: 952-249�1600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application fo�m must be compteted in full and all required information must be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: � / r / r ��3�/ <br /> Job Site Address: J �� L�V. l St✓��� Lo� Lu1�2. b <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Disp ay Home? Yes No <br /> If yes,a speclal everrt permit is required with Police Department and City Counci/approva!60 days prior to the event. Shuttle bus servke il be <br /> required unless applicant demonstrates sufficient on-sJte parking is avaTlable. Non Permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: / <br /> Name: ��-P.✓�� �1�,1.ti S D!Gj <br /> State License# Expiration Date: <br /> Phone: 4 — •- 1 office cell <br /> Mailing Address: ?�. t� t' Cit : +� • .a. ZIP: "-3 j <br /> Contact Person: r wv.So Applicant is: Contrac or / omeown �c�.�a o�.� <br /> Email and/or Fax: � u.u���,�,,., �_^� � k c. p�,aho�», <br /> PROPERTY OWNER INFORMATION: r <br /> Name: �f�'✓� ��.u5�/u <br /> Phone(day): �,- b / f <br /> Address: p �e� �• Cit :`a" �c•-rc� ZIP: ,��5-,(� <br /> Email and/or Fax ' �1�,,i <br /> ARCHITECT/ENGINEER INFORMATION:^.,,_ /� /� j,, <br /> Name: .�� w� ! I�'�-�� / ►���i 7 QC.�� <br /> Phone(day): �f!- �t'r �� 1 /� j , <br /> Address: _ _J��� Gr3� �,,� 'tJ�, City: �7, YO`�1 ZIP: �,5�(��'� <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 ❑beck <br /> Relocation detached garage ❑Office/Commerc�al ❑Private Sewer <br /> ❑Other: (speafy) ❑ 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) O er: (S eG � <br /> 18202 Minnetonka Blvd a��, �� <br /> Deephaven,MN 55381 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m i nnehahacree k.o r <br /> Estimated Construction Valuation(excluding land) $ ��p 5 � � <br /> � '� ���'� `�'�; , <br /> .,� k��� ����� <br /> �� � ;�` «`� <br /> G ..� <br /> � .r'' c: �k: <br /> � ��' � �� <br />