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City of Orono CC" <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: C go/7 — 6 l j <br /> PO Box 66 <br /> No Crystal Bay, MN 55323-0066 Date received: <br /> 1 Street Address:' Received by: 7 <br /> i a 2750 Kelley Parkway Plan review fee: <br /> Orono, MN 55356 <br /> �FsiiE Main: 952-259.4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.0 <br /> This application form must be completed in full and all required information must be submittecV,, �j F 01? <br /> Incompiete applications will be retumed. (Please print) c� b <br /> GENERAL INFORMATION: /� <br /> Job Site Address: C7`I°1 O Ol� iG0 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes El 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 INFORMATION: <br /> Name: Al,'c.Y_ �t2r�t Pfd �7 0��, f Ili 71 } <br /> State License# A-. Expiration Date: <br /> Phone: cell s r775' R01551 (office '7 b 3 <br /> Mailing Address: Po Ro v r.al Cit a,Jjk GLrrek ZIP: SS3) <br /> Contact Person: r Applicant is: C / Homeowner (circieone) <br /> Email and/or Fax: ,'04 foCo <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone(day): (01J — 00?— T <br /> Address: aY90 Ob 4tael lZvil City: 0(0,10 ZIP: $! ✓�j/ <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: _ <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 /> Addition attached garage ❑Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocationdetached garage ElOffice/Commercial ElPrivate Sewer <br /> Other:(specify) OOCL ❑ 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) Q[J <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> _=,rninnehahggreek.2M <br /> Estimated Construction Valuation (excluding land) $ �3 L O�4 <br /> Packet Last Updated: 04/1912013 <br /> Page 22 of 23 <br />