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� � <br /> � 5 ��3 <br /> �� � <br /> �(� �� 5 <br /> Cit of Orono '� ��' � <br /> Y � <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: p7�//-p(>� 9 <br /> O��,�.0 PO Box 66 l <br /> Crystal Bay,MN 55323-0066 Date received: �!�a �/ <br /> � a ��; ;�, �, StreetAddress:' Received by: <br /> �'.�, � y� Gti�' 2750 Kelley Parkway Plan review fee: Q 9 <br /> L9x�H0¢'F' Orono,MN 55356 o2G//_pG�a� <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 alt required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 8� �'p��t—�{ ►.-,100l� �'D , �3Ze t—►� . �� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or ot er Disptay Home? ❑ Yes � No <br /> /f yes,a special event permit is required with Police Department and Cify Council approval 60 days prior to the event. Shuttle bus service will be <br /> �equired unless applicant demonstrates su�cient on-site parlcing is availa6le. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: {��{ZTN E.�.�j � ��Sl��.{ <br /> State License# OlP 3'"['1'f(� Expiration Date: - 3� - 2012 <br /> Phone: C�12 - '(1't - 1}1}-•�}.-�} o�ce l01�.. - `lv� - St�92 Rlc.l-' cell <br /> Mailing Address: 'I 5 1-�A►z.IG�'f $T �Q"t City: '��•1r'LS ZIP: 55 �05 <br /> Contact Person: rL1G1G SLYL� (�S0 Applicant is: �r / Homeowner (CircleOne) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: TE pc�Y� Gt atn'•( C�'a,�.Y <br /> Phone(day): <br /> Address: I�{�,•.1eoG jzv c�cy: ��tot.t� ziP: 5535� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: PPa•?Nl�th �(' rJE5t�7� <br /> Phone(day): �/12 • 92'I• �{�4� <br /> Address: Z 5 M R+►a-`G'f.'� �. ��ty: M�..ti ziP: 56�}-0 5 <br /> Email and/or Fax: `Z.((��, � Pp•a•T N E IZS� L�E.St�►� . GO 1'v� <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑New Construction ❑Single Family with ❑ Residence <br /> ❑Addition attached garage ❑Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Deck <br /> ❑Relocation p�1 I I��,e� detached garage ❑O�ce/Commercial ❑Private Sewer <br /> �Other:(specify) Ylr�M1-K+� ❑ Multiple Family/Condo ❑Warehouse <br /> ❑Public ❑Storage ❑Public Water <br /> "`Any earth movement may require ❑Commercial ❑Other(specify) <br /> MCWD review 8�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.or <br /> Estimated Construction Valuation(excluding land) 5 . <br /> Last Updated: 4/26/2011 <br /> - 19- <br />