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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: V) I b -0a J <br /> ��,� PO Box 66 <br /> 0 Crystal Bay, MN 55323-0066 Date received: <br /> a ^- s, Street Address:' Received by: L tQ o � <br /> ,s, r1, 1 t o~ 2750 Kelley Parkway Plan review fee: ll <br /> �kESH�g� 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 applications will be returned. (Please print) <br /> GENERAL II <br /> Job Site Address:INFORMATION: 0 1 C� ( rl 9-g ) 2 Og�v <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? E Yes , ----N-6--- <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 unl- _..licant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR APPLICANT INFORMATION: <br /> I- e: O 7-e�c.4e/' Cc AS4r co ^J ;�,�(--- <br /> State License# _ gyp 7 �,2s...)6 Expiration Date: /2-lav-c,--• o / 2 <br /> Phone: 9.5-2-- cr?D-_ C.6 7c (office) 0(2 — j —2 t �, I (cell) <br /> Mailing Address: 1_,n C AzloN 'p- ,5, Cit • ZIP: '3(o <br /> y <br /> Contact Person: S71'fi9-sh /"ti9JS"---•- Applicant is: (Contractor / Homeowner (circle one) <br /> Email and/or Fax: 95 7 _ y 7Z — 5-6 70 <br /> PROPERTY OWNER JjJF �I�TION: r r� <br /> Name: PL ` /{ � g <br /> Phone (day): <br /> Address: Tv U O L7 C.rys79 I l`j4K ., ` City: Geo YV\ ZIP: <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: -D t^ l <br /> 1.Type of Project 2. Proposed Use 3. Structure Tylink 4. Sewage Disposal & <br /> CI New Construction Water Supply <br /> ❑ Single Family with CI <br /> ❑ Addition attached garage ❑ Garage/Accessory <br /> ❑AccessoryBuildingg Bldg. ❑ Public Sewer <br /> ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> ❑ Other: (specify) CI Multiple Family/Condo ❑Warehouse ❑ Private Sewer <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 c2...<„,....__ <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) <br /> 4856)°— <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />