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City of Orono <br /> l. °� <br /> Building Permit Application l 5 <br /> for New Structures or Additions <br /> --- Mailing Address: 0'�/a— �/S'�' <br /> /���0,�`•<� PO Box 66 <br /> Permit number: <br /> %,0 _ �',;, Crystal Bay, MN 55323-0066 Date received: �n7-� �' <br /> il �� . ,� <br /> '��a �'�✓� � ` a,�� StreetAddress� � �vedhv: ______ /Yj <br /> �' � �� '�� �!� 2750 Kelle Parkwa p n review fee: <br /> \\c� . o;, Y Y c� CIL � P� � 0 _..�. <br /> �kEsxo�`'�' Orono, MN 55356 � <br /> � ---- _ __--_. _� o�o/ a- O O$S <br /> Total Fee: _ <br /> Main: 952-249-4600 Fax: 952-249-4616 www.a.orono.rnn.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: 31 �,'� �!�,2 T�-� ��,�c=. a tZ i�y L <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> If yes,a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shutt/e bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ��0�'v�E�C�w�1[;Z <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: Ci : <br /> Contact Person: Applicant is: Contractor / omeowner �c���ie o�e� <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: I`�.(_,'��('tC� J v��� <br /> Phone(day): lc1 a - ►�- ��--11 <br /> Address: �1 l.o i�1G�2t�-1 S�U�E 1����� Ciry: ���t`�Z�'�TA ZIP: •SS=��1 � <br /> Email and/or Fax I��,k�c J�r�1�S�EA���� ►,1 S <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: 1-1L.�'v�E Uw rV�t� <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/ar 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 �Deck <br /> ❑ Relocation � detached garage ❑Office/Commercial ❑ Private Sewer <br /> �Other.(specify) �:-c-k � S�p�i2S ❑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.or <br /> QSL <br /> Estimated Construction Valuation (excluding land) $ � (�,C,e, <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />