Laserfiche WebLink
Ctatl <br /> y <br /> City of Orono 2-2 <br /> Building Permit Application <br /> for New Structures or Additions 0 707 a - 75 <br /> Mailing Address: Permit number. p /7j-b t <br /> KI --.---11,,,,:,0-74?- 4PO Box 66 Crystal Bay, MN 55323-0066 Date received: <br /> y,W Received b <br /> t` � Street Address:' Y� <br /> 1 cit , '+ �cp 2750 Kelley Parkway Plan review fee: L��35, tGj <br /> �$Ho� Orono, MN 55356 t)/ <br /> Total Fee: °� Ql5L2 <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 applications will be returned. (Please print) <br /> GENERAL INFORMATION: -` <br /> Job Site Address: SSo (AAC.v.0..\ %`- 49-6a41Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? El 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 INFORMATION: 11 <br /> Name: �G.�ts✓ Ihab1te% %..:\0� <br /> State License# Expiration Date: <br /> Phone: 7103.872,.1 4br (office) lel2-7q/-.T46) (cell) <br /> Mailing Address: Z 1. c. t .. Cit : . _ .; ZIP: g <br /> Contact Person: v„.%6 w Tvmor,04\4.,,, Applicant is: k on ra (AI, / Homeowner (Circle One) <br /> Email and/or Fax: %,,,..yd„, C Ise►.+. .av• c.e <br /> PROPERTY OWNER INFORMATION: <br /> Name: $sw. TtsN►r.•.a e..\ <br /> Phone(day): <br /> Address: 2Z o �yf�..\ S ve.. City: �.e�..s `e..�a.t ZIP: SSS 3 S <br /> Email and/or Fax &\.1S Lc. e.Jawk‘ee\ftw%e.e.% . e owe <br /> ARCHITECT/ENGINEER INFORMATION: ` <br /> Name: -?="A ttyty �v�e.�:444 FS <br /> Phone(day): 71e3.SS, • b <br /> Address: I SUM UM A. S.38 a 4• 1'1 O City: \yyv.l,„, ZIP: s. 44‘, <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> ❑New Construction 0 Single FamilywithWater Supply <br /> 9 0Residence <br /> ❑Addition attached garage 0 Garage/Accessory Bldg. Public Sewer <br /> 0 Accessory Building 0 Single Family with 0 Deck <br /> 0 Relocation ` detached garage . KOffice/Commercial ❑Private Sewer <br /> l Other:(specify) t*i tv v., 8.:.\A•ta'0 Multiple Family/Condo Warehouse <br /> 0 Public 0 Storage IA Public Water <br /> "*Any earth movement may require glommercial 0 Other(specify) <br /> MCWD review&permits. Industrial ❑Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 Other:(specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation(excluding land) $ twidicepsett.4 1/,tkbi0elO <br />