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` / • �. —� � �� �.�. <br /> � ,. .�.�, � � �_._ �.. <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �C�/� -�/ O�o <br /> ���O,j� PO Box 66 <br /> O Crystal Bay, MN 55323-0066 Date received: //- �Ll <br /> � u�` Received b <br /> +�,a '�{� ' �. , Street Address:' y� <br /> ��'� ,�y�.�G��'/ 2750 Kelley Parkway Plan review fee: 1 7� .� «5�,3 <br /> ,gESHo�`,// Orono, MN 55356 ao,a -a,��,o� <br /> �--_--� Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 v��ww_cl_ororc.mn.us <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: �� �f �J /`���GS a„ � �R � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will 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: S�v�,� w a o.�,� 1. L � <br /> State License# � D S9 �3 ! 5 Expiration Date: <br /> Phone: - �9 6 office 2 Z cell <br /> Mailing Address: �y G✓ � v . Cit : ZIP: ' Z � <br /> Contact Person: ,.$� v l Applicant is on ra tor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTYOWNE NFORMATION: ' '����� l 1� � `r\tr3� <br /> Name: D� � 1L �a �•l �P ti o F- <br /> Phone (day): � - � - /1 <br /> Address: /� 2 Z.r C., ,� � rM ,.� (��{�� /Pr.t� City:��l'+h �ra rh�'r ZIP: S,5�3`f,G <br /> Email and/or Fax _L� 1"c v..� ; :='f � � ,•�t,�-.;,-� . ti��.� <br /> � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: A/��a., �r.� /�p r:s� Gr�u � <br /> Phone (day): �f 7 ? J <br /> Address: v ,c�'a t r ,f��. �f Cit : ti 7' t ziP: SS 3 9/ <br /> Email and/or Fax: r P <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 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.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � <br /> �f <br /> � +;� ,,-:�-• <br /> �- <br />