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. � <br /> � <br /> City of Orono � <br /> � <br /> Building Permit Application � <br /> for New Structures or Additions <br /> Mailing Address: Permit number: ���y—D/�� <br /> � �� PO Box 66 <br /> � Crystal Bay, MN 55323-0066 Date received: /a"��—/ <br /> , � Street Address:� Received by: '�� <br /> � '� � 2750 Kelle Parkwa ��3 � <br /> y�, �/ Y y Plan review fee: <br /> c.� Orono, MN 55356 <br /> �'�KesHo�� Main: 952-259-4600 Total Fee: ����/— ��`��� <br /> Fax: 952-249-4616 <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: / <br /> Job Site Address: ��0 l�q r- fen c.v ao �cf �ro»O �`f/l� 5,5 35�o <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home. ❑ Yes No <br /> lf yes,a special event permit is required with Police Deparfinent and City Council approval 60 days prior to the event. Shuttle bus service wi!!be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted evenfs will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: , <br /> Name: T oM on on�-�ru��loh �. L.G <br /> State License# f3 G C� 8 6 9 85 Expiration Date: 31 a o i 6 <br /> Phone: cell �j ,2- - office <br /> MailingAddress: SOS n Cit : o ZIP: 55� (0 <br /> Contact Person: L�or�1 qr1 oy� Applicant is: �on rac o / Homeowner (CircleOne) <br /> Email and/or Fax: ' p <br /> PROPERTY OWNER INFORMATION: <br /> Name: /'�rr k an al l�et/+� /T�ooi"e- <br /> Phone(day): $2 � q � — $ p <br /> Address: '��Q � Cit : s�j,p�^.e OB ZIP: rJ 533� <br /> Email and/or Fax K p r <br /> ARCHITECT/ENGINEER INFORMATION: , <br /> Name: !�. F'. P Plan•��n4 ¢' ��5lQJ� <br /> Phone (day): �(0�3— �$0- g0�� �-/O(� <br /> Address: �f�b O a or� S N� �ui�'L Cit : q 'p ZIP: .'r,�.5 <br /> Email and/or Fax: i'n fo � OFP 1�E.�!Lt it/e c� <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8 <br /> Water Supply <br /> �New Construction �ingle Familywith �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 (specify) ❑ 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.minnehanacreek.or <br /> Estimated Construction Valuation (excluding land) � �45 � �O� �— <br /> --� <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />