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. � � <br /> ' q � � � -�. --«� �l i �l P1o�� ��. <br /> � ���� <br /> ,, ��� ` � ����d= S . <br /> City of Orono �� �e� <br /> ' Building Permit Application `� `' `�"` � E�'-r `'�� <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �CUOq�-p- <br /> 'Qv�,�j PO Box 66 <br /> Q �� Q Crystal Bay, MN 55323-0066 Date received: ��Z�l��-j <br /> � Received b ��� <br /> �� <br /> �� �`� `»�' a. Street Address:' Y� <br /> e;:� <br /> �� '� '� ti�' 2750 Kelle Parkwa <br /> �o Y Y Plan review fee: �a •�c�l ` 7 & <br /> t`47fESKp4 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. (P/ease print) 1G <br /> GENERAL INFORMATION:. / <br /> Job Site Address: ��Uv �h����(�5 ��V1✓� , �YC►1 G , �ti1/1/ `j���� <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 Depariment and Ciry 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 wil!not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: . <br /> Name: C�1 Vi 5 �, ��'Vl �.���'t�l (1'1 <br /> State License# Expiration Date: <br /> Phone: �. �v � office cell <br /> Mailing Address: 00 1 i i YI 1/!i Cit : ' L' ZIP: ' . 3��': <br /> Contact Person: � Applicant is: Contractor / me ner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFOR MATIO • -�� L �" <br /> Name: �!�j VjS �C'T Li f pvl.� l� <br /> Phone (day): � lj pQ 0 <br /> Address: 0 1 � V� Cit : I�C��/!!� ZIP: �5.35 <br /> Email and/or Fax r �� <br /> ARCHITECT/ENGINEER INFORMA ION:, <br /> Name: � �llh 'L?l f�G�� s <br /> Phone (day): - <br /> Address: DO j�i�i7 . ,c' �� . Cit : � ZIP: ��/�fi <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> ❑ New Construction i e mil it �Nater Supply <br /> �'Addition ❑ Residence <br /> r g ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building Single F ily ith ❑ 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& permits. ❑ Industrial �"hr-C�C ��5� ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ��� <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 UN C x�S 1 rw� �(1.C.�C <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � �D <br /> -20 - <br /> �i <br />