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. . � <br /> � <br /> � <br /> City of Orono � <br /> . . . . . � <br /> Buiiding Permit Application � <br /> for New Structures or Additions <br /> Mailing Address: permit number: �d��f—���� <br /> �A: PO Box 66 <br /> � f v� Crystal Bay,MN 55323-0066 Date received: /a��G'"/ <br /> StreetAddress:' Received by: `�� <br /> � ,� 2750 Kelley Parkway 5'�3 � <br /> 9�, Plan review fee: <br /> �` Orono, MN 55356 <br /> �'��ESNo��' Main: 952-259-4600 Total Fee: ���/—����� <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be compieted in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INF�RMATION: / <br /> Job Site Address: ��3 0 �°a r fen c,v oo �cF �rOnO M/1� 55 35!o <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home. ❑ Yes No <br /> /f yes,a speciel ever►t permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> r�quired unless applicant demonstrates sutncie�t on-site parking is available. IVon permitted evenis w1J1 not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: , <br /> Name: T o/►� on oti�5�'/^ Gfloh L LG <br /> State License# �8'6 9 8S Expiration Date: 1 01 O / <br /> Phone: cell office <br /> Mailing Address: 505 Cit : d ZIP: 5� (� <br /> Contact Person: L�d rf q rJ pn Applicant is: on rac o / Homeowner �ci�.o�.� <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �r pQ/r� /?'1 oor� <br /> Phone(day): 2 J 9' � — O <br /> Address: �- Cit : S r�. o ziP: 5 5 3 31 <br /> Email andlor Fax K p <br /> ARCHITECT/ENGINEER INFORMATION: , , <br /> Name: IJ. . J� Pfa�r>>/z ¢ .�G <br /> Phone(day): — � 0— .�./O� <br /> Address: q' D O a or� N� �ui fG Ci : ZIP: 5S <br /> Email and/or Fax: o F ! it/ <br /> PROJECT INFORMATION: Description of pro'ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Dtsposal 8 <br /> Water Supply <br /> �New Construction �ingle Family with �Residence <br /> Addition attached garage Garage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑Other: (speoify) ❑Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD revlew&permits. ❑ Ind�strial �Private Well <br /> Minnehaha Creek Watershed Disfict{MCWD) ❑Other. (SpeC'rfy) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehah creek.or <br /> Estimated Construction Valuation (excluding land) � �'ds � �O� � <br /> Packet Last Updated.• 04/992013 <br /> Page 22 of 23 <br />