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, � ��� c1� � �� Pl c�-ao��� <br /> O � ao�a <br /> �5 t53•� . <br /> 8� .�° __ <br /> City of Orono ' '�����.�o ���'� <br /> Building Permit Application � b � <br /> for New Structures or Additions <br /> MailingAddress: Permit number: aot3�QO DO? <br /> �%�O,j�j.� PO Box 66 <br /> '+;'�0 Q�, Crystal Bay, MN 55323-0066 Date received: � �, d <br /> 'k��' 7� � Received by: <br /> ���'a '�l �,;, StreetAddress: /- <br /> �\�',�e,t,�����, ��!` 2750 Kelley Parkway Plan review fee: �1� �.� <br /> ��`�gEsi�og�/ Orono, MN 55356 <br /> `_`-___ � Total Fee: 02013-�(�OB <br /> Main: 952-2491t600 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: Nas a F�-Z '� -. Z <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <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 /> COiVTRACTOR/APPLICANT INFORMATION: <br /> Name: s�o�.-c�..rcc.2 _ �� c., <br /> State License# Zo5`1y31� Expiration Date: <br /> Phone: q S 2 -�a'1-55 4 0 (office) (cell) <br /> Mailing Address: ? n �1� -�.,T... 31� Cit : -�. �,,,�i �� ZIP: 55c.n,6 <br /> Contact Person: SVc� G►�-��+ Applicant is: C trac r / Homeowner (CircleOne) <br /> Email and/or Fax: SJ<� 0� S-�cn<.J�L.��� — <br /> PROPERTY OWNER INFORMATION: <br /> Name: M:K.� �s Rrn-� Sw�,��-c- <br /> Phone (day): �tSZ- S`t7- 3�59 <br /> Address: _ v��r o�,.rZ Mr� City: ��cw� ZIP: 55"i'�t <br /> Emd'll 2tld/Oi F2X M�i � 5w►.�(1�t � V�.�.00. C c�-- <br /> AR�HITECT/ENGINEER INFORMATION: �N� � S c+-rx�I�G <br /> Name: �c.��i., ��C„�,�..f <br /> Phone(day): q5 y�y 3_ g��-� <br /> Address: �/n1 Y�+�'i 5'�" � Ciry: �yzh-fti "" <br /> Email and/or Fax: _�,,r� k���!„r �.;,�,� �„�..,,,,� . � �_ ���� ����..���� <br /> PROJECT INFORMATION: � r�,{ <br /> 1.Type of Project 2. Proposed Use 3.Stru� � �� aV�- � � ����0.� <br /> ��� �v�� <br /> � New Construction (�Single Family with �Resic ��_ (/�' �. <br /> ❑Addition attached garage �Garac C��/�� `"" <br /> ❑Accessory Building � amil with ❑ Deck �I ,� <br /> ❑ Relocation � det ❑Office/ �,I.U�v'� <br /> ❑Other. (specify) ❑ Multiple Family/Condo ❑Warehi �("L.{��J � <br /> ❑ Public ❑Storage � <br /> **Any earth movement may require ❑Commercial ❑Other(s <br /> MCWD review&permits. ❑ Industrial t- �GJ� <br /> Minnehaha Creek Watershed District(MCWD) ❑Other. (speCify) � i <br /> 18202 Minnetonka Blvd �� � ,C �`j�� , <br /> Deephaven,MN 55391 � ,q n <br /> Phone: 952-471-0590 � � - . �( F'��-(% <br /> Fax: 952�71-0682 j-��� W ' <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �� 1 S� , >S <br />