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, <br /> City of Orono <br /> . . . . �. � <br /> Building Permit Appiication l � <br /> for New Structures or Additions <br /> Mailing Address: Permit number: 0��0�"-�SS <br /> O�,O,�.O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: ��7-�y <br /> � s, Street Address:' � � <br /> Gti�' 2750 Kelley Parkway p�{ C� � ��n review fee: � 8 <br /> ��xo¢� Orono, MN 55356 T �` <br /> To t a l Fee: O�D/ a-O O$S <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form musfbe completed in full and all required°information mustbe submitted. <br /> Incomplete applications will-be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 3l�'C.o q���t�� St��E 17+��v� <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 approvel 60 days pria to the event. ShutUe bus service will be <br /> required unless applicant demonstrates s�cient on-sife parking is available. Non-permltted events will not be allowed. <br /> CONTRA�TOR I APPLICANT INFORMATION: ':�" <br /> Name: 1��rv�E�ow►•t G-iZ <br /> State License# � Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: Ci : <br /> Contact Person: Applicant is: Contractor / omeowner �cir��o�� <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: M�C,�+('��� 3�E S <br /> Phone(cfaY): (�1 a, -i 1�- ��-1`1 y <br /> Address: _ __�1 l0 1�1p2tN SWO�E L��'��E City: 1�R'�'L�TA ZIP: SS39� <br /> Email and/or Fax M��kC 0.� SOn1ESfEA iM. U S <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: 1�C��ME C�v.9 NE tZ <br /> Phone(day): <br /> Address City: ZIP: <br /> Email and/ar Fax: <br /> PROJECT INFORMATION: <br /> 7.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 /> �aner:�spec�y� ►�.�k � 5i�l2S ❑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: 952-471-0682 <br /> www.minnehahacreek.o <br /> RSL <br /> Estimated Construction Valuation(excluding land) $ �.(�(; <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />