Laserfiche WebLink
cit nod <br /> lo UP <br /> �ITY OF O <br /> 11" BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �Ol VO Mailing Address: /Receid <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 - <br /> Street Address:' �l2750 Kelley Parkway S`fy 0 9Orono, MN 55356 r,t 0), <br /> SHMain: 952-249 4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required n// Id ubmitted. �jj <br /> Incomplete applications will be re_ turned ( ase rih J (/ <br /> GENERAL INFORMATIO / 17.30 <br /> '�d ( el A f°' <br /> Job Site Address: 3' © !U <br /> Will this be a Parade of Hollies, Remo eters Showcase Home r other Display Home? ❑ Yes [ No <br /> If yes, a special event permit is required with Police Department and City Council a ,oval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. No ermitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: 1�5 t--lov�v> mac <br /> State License# �L 2(o`tlo' b Expiration Date: 0 3 3l l S <br /> i~J <br /> Phone: cell (.ct ct office 1 i�,3 y a�;_ ;'333 <br /> Mailing Address: 'D 11 7 =t 1111— Cit : Na fV- - ZIP: 5 S 3 <br /> Contact Person: A4 a� Ww Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: ✓.1 a,LG °,,A—e,5 OA C_<)-A 7b '390 00"-( <br /> PROPERTY OWNER INFORMATION: <br /> Name: e,1 ,-, ,f,4 5 1/4 <br /> Phone (day): 7b 5_6S Zaoo <br /> Address: zs' Acf N Citv: Sf Cl0i4 ZIP: 5 30j <br /> Email and/or Fax Q� RVA.; <br /> ARCHITECT/ENGINEER INFORM ION: <br /> Name: Gry i K S� '` <br /> Phone (day): ­ " a `I <br /> Address: Zq i 3 I-h 11 u/ City: AtId�1' ZIP: <br /> Email and/or Fax: 5- 303 <br /> PROJECT INFORMAT N: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> ® New Construction eZ Single Family with Residence <br /> []Addition attached garage ❑ Garage/Accessory Bldg. El Public Sewer <br /> ❑Accessory Buil ' g [:1 Single Family with El Deck <br /> ❑ Relocation detached garage ElOffice/Commercial El Private Sewer <br /> El Other: (speci ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage Public Water <br /> **Any earth movement may also 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) $ 'z_e; / O <br />