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r � . t / � <br /> -. V �((� ��, <br /> . <br /> �� ���� <br /> City of Orono ' <br /> � � Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number. L L.' �� - � �C ,(�` <br /> �.,��� PO Box 66 � <br /> Q �,\ �\ Crystal Bay, MN 55323-0066 Date received: �' ' ! ( /C <br /> .`� 1 <br /> � a �'� � �, Street Address:' �—�-'fC�— �����`� Received by: (=_'_T_� <br /> t 4.'•y J <br /> �� ������'"��, Gti/ 2750 Kelley ParkwayL'�L� Z����1�,� plan review fee: i, ��`j �� � � <br /> ��k�1fi\�04� Orono, MN 55356 <br /> Esx � <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 alI required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATIONr�?(;,��;(_:� i�= �,\� �-,Z,y�,-��- � <br /> Job Site Address: � � �(,� - <br /> Will this be a Parade of Homes, Remo elers Showcase Home or other Display Home? ❑ Yes �No <br /> If yes, a specia!event permit is required with Police Department and City Council approval 60 days prior to fhe event. Shuttle bus service wi(1 be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: fl_��f Q,�� �ow��s <br /> State License# ac�3�SSS5 Expiration Date: 3 -31 —�� <br /> Phone: _ � office y _qqd�- 4�tQ cell) <br /> Mailing Address: -7 Cit : H nJ� ZIP: 55 <br /> Contact Person: ��y ,��(,�,��� Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: � c�c,,�—c���_ �pbg <br /> PROPERTY OWNER INFORMATION: <br /> Name: �'c�..��� � Ju.lcc�tiv� ��r.�e�n <br /> Phone (day): a,-- S _ �7o,c� <br /> Address: ��SS �� Y ��� �, City: o�ro�no ZIP����3� <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: �ot.v�C, a�S �.ovr�-'�'b�r <br /> Phone (day): <br /> Address: Cit : ZIP� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal 8� <br /> �New Construction Water Supply � <br /> �Single Family with �esidence <br /> ❑ Addition attached garage ❑ Garage/Accessory Bldg. f�Public Sewer � <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck � <br /> ❑ Relocation detached garage ❑ Office/Commercial � <br /> � P fY) ❑ Mul�i �e Famil /Condo ❑ Private Sewer <br /> ❑ Other: s eci � <br /> p y ❑Warehouse <br /> ❑ F�blic ❑ 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 `4�; <br /> Fax: 952-471-0682 � <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 3"j �'"-�', d� � j <br /> Last Updated: 9/29/2009 <br /> - 17 - <br /> I _ _ <br /> u � <br />