Laserfiche WebLink
City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: a0/��/?J 7, ' <br /> 0A, PO Box 66 <br /> l VO Crystal Bay, MN 55323-0066 Date received: l/— h"/'`/ <br /> Street Address:' Received by: !7/j <br /> A 2750 Kelley Parkway Plan review fee: �� -- <br /> F C` Orono, MN 55356 _ <br /> t�'�ESHO�ti Main: 952-259-4600 Total Fee: ./37�-- -� <br /> Fax: 952-249-4616 www.ci.orono.mn.us a`GVnVf/ Irtc 1 {- , <br /> This application form must be completed in full and all required information must be submitted.2/ A v7S- <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ys& OL& LOI1J6 ,U4KE Roc) l-t,ilz af4 in Al SST' <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Disay Home? ❑ Yes 3 o <br /> /f 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: SCA war-z_ DcciIckerS -TAC_ <br /> State License# gc oo 9a o1 Expiration Date: 3/31/ 0/49 <br /> Phone: (cell) WV- 38Ce-b'vq3 Y.Vr-\-. (office) 951 -117( - - 76,(s--- <br /> Mailing Address: a4/0 Mi ncj•toAkq X vc S , rte. )0 Cit g ZIP: 5539/ <br /> Contact Person: k r-t SeK.aeu—r.. Applicant is: ontracto / Homeowner (Circle One) <br /> Email and/or Fax: kurt (6) 5du-Jar Z) 106rS . C o Y1'1 <br /> PROPERTY OWNER INFORMATION: <br /> • <br /> Name: ('_i.r(St ('e r Poi, c/n ski <br /> Phone(day): S - 3 5-aS00 <br /> Address: 4'50 OloL Loveq za4 go( City: L.Jaft-z.a,144 ZIP: 553`? <br /> Email and/or Fax c;p(id.i Ask( Q /l ndo[ s &carv'l_ <br /> ARCHITECT/ ENGINEER INFORMATION <br /> Name: s/},L j1r" % dS L 7" <br /> Phone(day): 9,5-, - j' t, - 7gq/ <br /> Address: .21-EDini/14ata .4 f9Uc S.) Surfc ..1.p/ City: (it)4 z�,fet ZIP: 5 5- 39 J <br /> Email and/or Fax: Sa 14 rc_k 97 Co gr a.i l . cart-1/4_ / 1 <br /> PROJECT INFORMATION: Descri.tion of .roject: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑New Construction Single Family withResidence <br /> 2 ,ddition attached garage [Garage/Accessory Bldg. ,Public Sewer <br /> ❑ •ccessory Building ❑ Single Family with ❑Deck <br /> ❑ Relocation detached garage 0 Office/Commercial El Private Sewer <br /> ❑Other: (specify) 0 Multiple Family/Condo 0 Warehouse <br /> 0 Public 0 Storage 0 Public Water <br /> **Any earth movement may require 0 Commercial 0 Other(specify) <br /> MCWD review&permits. 0 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.mi nnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ c7.53-0i COO <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />