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� <br /> � <br /> � � (l� <br /> City of Orono � � <br /> , . �� ,�,�- <br /> Build�ng Permit Application �, � <br /> for New Structures or Additions � � <br /> Mailing Address: = ' : <br /> '�,;.{�,� _ PO Box 66 1��kt�ulmb�r ��t '�J ' d'O�l�,:.:- <br /> � Crystat Bay,MN 55323-0066 ���4����y� , ._ �':� f� _ <br /> n�.F w '� -- - <br /> Street Address: ��e��gd qfy° .� } <br /> � 2750 Ketley Parkway ' M - ' <br /> '� � - F�l�ir��r���t��nr}�e�e , ��� � <br /> �' rr� : Orono, MN 55356 � ` <br /> `� ' , r�. .. Main: 952-259-4600 ' �i� 3 DQa� !o : <br /> ��,��?t�e�� . <br /> Fax: 952-249-4616 www.ci.orono.mn.us ��+ �.:���i��, �� '�,-^ . <br /> �� k� -- <br /> � <br /> ��'� (Please print) � <br /> GENERAL INFORMATION: <br /> Job Site Address: �..�� ���, �k���., � r(����, � �� ��3�� <br /> Wiil this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �,No <br /> If yes,a speclal everrt permltls regulred with PoOce Department and Clty Councll approva/60 days pdor to the event Shuttle bus servlce wlll be <br /> �quired unless appUcant demonsbates sufffclent on-sfte parking Is avallable. Non permitted events wlll not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �� '��� ���� <br /> State License# ������ Expiration Date: ����—��o� <br /> Phone: cell (�I�—S �—� � office — 44 — eq� <br /> Mailing Address: ��'�I� �a..� Cit :�(a h� ti'� ZIP: ���`.Q <br /> Contact Person: Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: � �� � o �,� <br /> PROPERTY OWNER INFORMATION: �ar� c�� '� `SYI�" Y�(��� <br /> Name: �s�t�► �- �.Y'������5 �I Y�,���A� <br /> Phone(day): <br /> Address: "Z � �,� Cit : �� � ZIP: ��a3�� <br /> Email and/or Fax w�v1� �� <br /> ARCHITECT/ENGINEER I FORMATION: <br /> Name: � �j��(��� �� <br /> Phone(day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro'ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> �New Construction �,Single Family with �Residence Water Supply <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. '(�j,Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑Reloca�on detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑Other. (speciiy) ❑ 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 Bivd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �a,�� �� <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />