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City of Orono 07 lb 7 <br /> Building pp Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: 13 -00 <br /> PO Box 66 D <br /> `V Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' Received by: <br /> 2750 ZKelley Parkway F � y y Plan review fee: 7• <br /> Orono, MN 55356 <br /> !1kESHOMain: 952-259-4600 Total Fee: DO <br /> 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: 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 approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORM�4�ION: <br /> Name: P>VA-6 (ei�1� �V`�ic�rirW,K <br /> State License# J Expiration Date: <br /> Phone: cell - - - 1 , office <br /> Mailing Address: V I `` A.C. A,-e14-l1- Cit ,01.1 ((A.kf ZIP: <br /> Contact Person: ✓a- " -A_0—'11N,,-,P � Applicant is: Contractor' / omeown (Circle One) <br /> Email and/or Fax: kcvatM'a-i <br /> PROPERTY OWNER INFORMATION- <br /> Name:Name: gjVcA�,G4 AwayA� (Auevmev- <br /> Phone (day): (�;GC�,- - 3 S- tZ-1 S <br /> Address: -7-1 Zo City: L0vk-'0 l GiK� ZIP: �� 3 <br /> Email and/or Faxlnvc��wVaey,VeKtiC4v,6" 1. C_,t, , <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: Lz;L,-C_u. <br /> Phone (day): 4-<;-!- D t4 b c1 1'L- "1 t q - '1C1"Z-U <br /> Address: t u!2�.Z_p City: O./vyx�ia ;N C ZIP: t®(e)1 3D <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion ofproject: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> _ Water Supply <br /> New Construction [Single Family with Residence <br /> Il 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) ❑ Multiple Family/Condo ❑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: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ S q <br /> Packet Last Updated: 03/29/13 <br /> Page 23 of 24 <br />