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� , ���� <br /> 5 <br /> ��� <br /> City of Orono A�'� � � �� <br /> Buiiding Permit Application c�� �� ���'�� 5556.�s <br /> for New Structures or Additions 3o5�.7S Tz3��� <br /> ,_—� Mailing Address: Permit number - �/ 7� <br /> ���,�:\ PO Box 66 <br /> ; Crystal Bay, MN 55323-0066 Date received: <br /> O :� 01 <br /> ' '�� Received by: � '� � <br /> � a � �,; StreetAddress:' vc,., � <br /> �, , <br /> �\`��, � � Gti� 2750 Kelley Parkway Plan review fee: � �5 � r7 / � <br /> �,Ly;Y���� Orono, MN 55356 �G �1 � y��/L <br /> `�,E3H� � OZO OCJ— UO �7Jo ( <br /> -- Total ee: <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: <br /> Job Site Address: 318(n PIo2�4� Ho�2. 1 <br /> �II this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> !f 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 demonstrafes sufficienf on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: G�E� 1��'D'�ER�nnE`�f�2 <br /> State License# Expiration Date: <br /> Phone: (offi�) L I a�°I t la-�I S O o (cell) <br /> MailingAddress: '7oq M�1.tiNEZ�NICA 1���.H�c��.� �n� City: �o�vc� �p+�KE Z�P� 553S�o <br /> Contact Person: Applicant is: Contractor / omeown (Circle One) <br /> Email and/or Fax: G1E N o'�. KM HERECT�i25 CoM <br /> PROPERTY OWNER INFORMATION: <br /> Name: C�\EN Ne'DDE2rv�.E`(E12 <br /> Phone(day): (01 a —`i l lc - '�i 5 O O <br /> Address: "Toq M �ntrtETor�Kp I-}tc�t+lAN� Lnr City� �oNt, L�kE ZIP: SS3S�o <br /> Email and/or Fax ��E,�', kMHER cc.�oR S� Orn <br /> ARCHlTECT/ENGINEER INFORMATtON: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal� <br /> Water Suppty <br /> �New Construction �Single Family with �esidence <br /> ❑Addition attached garage ❑Garage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Dedc <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 8 permits. ❑ Industrial '�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�71-0682 <br /> www.minnehaha creek.or <br /> Estimated Construction Valuation (excluding land) $ �feD,, o G>� �c'-� <br /> - 18- <br />