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. j <br /> � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: ,� <br /> 'gv 0.� PO Box 66 Permit number. �L ��� •-(�,�C;(�,� <br /> Q � Crystal Bay, MN 55323-0066 Date received: 2 ! �� �U <br /> � ��' s. Streef Address:' �-'fC�— Z��Co� Received by: (=?T7 <br /> ��t y ���F 2750 Kelley Parkway�'(L,'� ZS�(��#- Plan review fee: � �S� � � <br /> `�ESHo4 Orono,MN 55356 <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 all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �f�SS ��� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> lf yes, a specia!event permit is required with Police Department and City Counci/approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is avaifable. Non-permitted evenfs will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: !�, Q r�,� �c'�v�nc-S <br /> State License# an��SS _ Expiration Date: � -��.-._(p <br /> Phone: q office �{ _q4c�_ �e� cell <br /> Mailing Address: -7 Cit : „� ZfP: 5 <br /> Contact Person: _�y ����� Applicant is: ontractor / Homeowner (CircleOne) <br /> Emaif and/or Fax: � c�s�—�4�� Y�bB <br /> PROPERTY OWNER INFORMATION: <br /> Name: �iwco� sf. Ju�cc�v�v1 � <br /> Phone (day): q S'oL^ -t 1 - "'7o�i4 <br /> Address: �LSS �,Qd�w�� �, Cit � ��ro�nb ZIP•5��3� <br /> Email and/or Fax � <br /> ARCHtTECT/ENGINEER INFORMATION: <br /> Name: �otv»e, c�.S �ovr��^.s�ir <br /> Phone (day): <br /> Address: �itY. Z�P. <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 �Single Family with �esidence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. �Pubfic Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse ❑ Private Sewer <br /> ❑ Public ❑ Storage �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.or <br /> Estimated Construction Valuation (excluding land) $ '3`j c�'� �� .� <br /> Last Updated: 9/29/2009 <br /> - 17- <br />