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, , <br /> City of Orono �,, <br /> Building Permit Application DLi���.s•�-1� <br /> for New Structures or Additions <br /> Mailing Address: Permit number: A b/:� --cot/y,,, <br /> ,v.0, . PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: / / / //c <br /> ' 4 7z , Street Address:' <br /> _ R�=e'ved by �r� <br /> \..,1' <br /> r j ��! 2750 Kelley Park ay 3 -cq Plan review fee: I G( tr� l e j[ 4,235 <br /> \,,Azs-14.0- Orono, MN 55356 • 01,3-00-14-1 <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 a plicatio s will be ret ned. (Please print) <br /> GENERAL INFORMATION: 2. C1 Ot IV. ,4 Yen u`L <br /> Job Site Address: :..a Ie, t-� L 1 ` �-, �,cs. lce.e ve- (4,1,:•Y� <br /> Will this be a Parade of Homes, Remodelers Showcase H or other Display Home? es ❑ 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: 1�(era.,.... 4 %- s. Li 18,-,-,..... ; .l,.v.c, <br /> State License# 7...0(„ 43q Expiration Date: 3/3 i / 1 <br /> Phone: `"t(03, 4't -q - 4 c, (office) 1tc3 - 7.4.4- ( 3 O 1 (cell) <br /> Mailing Address: 41c ca � .1?-,Q- l q Cit : vnol'I�f,kvLaa- ZIP: 53z5i <br /> Contact Person: ._, -� Gam_ Applicant is: ontrac or / Homeowner (circle One) <br /> Email and/or Fax: .. gh,•so-e-, C e ec ,o +tiS0.n bprn s, et„- l(,::,3% 4-'Tq /4 L 1 <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: .4c t'►vlsa� I—Lii Tn� <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ''New Construction IKSingle Family with Residence <br /> ❑Addition attached garage Garage/Accessory Bldg. gPublic Sewer <br /> ❑Accessory Building 0 Single Family with 0 Deck <br /> 0 Relocation detached garage 0 Office/Commercial ❑ Private Sewer <br /> 0 Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public 0 Storage 0 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 <br /> www.minnehahacreek.org <br /> Estimated Construction Valuation (excluding land) $ 1s$,c <br />