Laserfiche WebLink
♦ <br /> . <br /> _',__. �C; /�,; � G�C; �,,� <br /> . � � .� ; �� <br /> �v� ���f'� �� C�..i s_.- �" -� � ���'�-� <br /> ��� � � City of Orono ����- '�-'� �� i=C� <br /> Building Permit Application N �`���;� ��j'C <br /> ui ing Permit Application <br /> D E N I 6� ew Structures or Additions <br /> F�@8 d@t1181:���� Mailing Address: Permit number: D Q-OO�v�� <br /> �„�(,t � CS Box 66 <br /> ,:,:, <br /> �G� stal Bay, MN 55323-0066 Date received: 7�o�aj /d <br /> �j,, �' �� a.�jL�,�� � Str tAddress:' Received by: ���( <br /> �a!��;',�� _�"at4:�����50 Kelle Parkwa <br /> � �,� `,��� �o -'( Y Y Plan review fee: <br /> �t kEsxo�'' Orono, MN 55356 <br /> Total Fee: <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 appfications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: f Q�G� <br /> Will this be a Parade of Homes, Remodelers howcase Home or other Display Home? ❑ Yes o <br /> If yes, a special event permit is required wrth Police Department and City Councrl approvaf 60 days prior to the event. Shuttle bus servic will be <br /> required unless app/icant demonstrates sufficient on-site parkrng is available. Non-permitted events will not be allowed_ <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �/71(/G �-W' /�. U6�-,G�i�G �S <br /> State License # � O 2 S 2-- Expiration Date: � <br /> Phone: Z — (office C��Z �.' - (cell) <br /> Mailing Address � ,v N � J�, Cit : /Lk�- I P:�'f q <br /> Contact Person: �- Applicant is: Contractor / Homeowner (Circle ne) <br /> Email and/or Fax: a���� �_yy� UG���,� , �y� <br /> PROPERTY OWNER INFORMATION: <br /> Name: � G!C/� �0 <br /> Phone (day): �- Z- � O 0 O � <br /> Address: /SC' i — tJs��f- �'i 4/�- City� ��� ZIP� S S'4/ �j <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: .S'/y�UGGL-LG!( �fZ�GL/�C,��— <br /> Phone (day): 9S`Z �' Zc�' J�'a <br /> Address: - �` �}.�"� N6 � Cit : �l�CI Z�P: s r4 3 <br /> Email and/or Fax: � Ga � � , <br /> PROJECT INFORMATION: <br /> i1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� <br /> I Water Supply <br /> ❑ New Construction ❑ Single Family with ❑ Residence <br /> ❑ Addition attached garage ❑ Gara e/Accesso Bld <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck9 ry 9' � Public Sewer <br /> Relocation , detached garage ❑ OfficelCommercial <br /> Other: (specify) �C/�v�G/� P��K k � Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑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) �Other: (specif�) <br /> 18202 Minnetonka Blvd �t„L�jv�•L/, f,5�7,l�j�i <br /> Deephaven, MN 55391 <br /> � Phone: 952-471-0590 <br /> ' Fax: 952-471-0682 I <br /> www.minnehahacreek or <br /> Estimated Consiruction Valuation (excluding land) $ Z,�j �� � <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />