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� .. �i� <br /> *� � _ <br /> �rV� / <br /> �<�y <br /> 3��� og <br /> city of orono 10 <br /> . <br /> Building Permit Application <br /> for New Structures or Additions l <br /> Mailing Address: , �;-• <br /> A,. PO Box 66 Permit number: � �> '•� t <br /> �O`VQ Crystal Bay, MN 55323-0066 Date received: ' I 3-- <br /> Street Address:' ;-- ----- Received by: ------ <br /> � �- 2750 Kelley Parkw y �� �C`� 3 �' ' � �'� i f{ �" <br /> y � �v�c-�d-�., ; ,�lan review fee: � , <br /> �'� c,` Orono, MN 55356 ��!�'��.� N�`� � � � ��5•y� <br /> '�kESNo¢�' Main: 952-259-4600 --1.'�: �r �•r,C � � ^�'U� . �`' I <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> e f;�SC�1'01N r� <br /> This application form must be completed in full and all required information must be submitt . x�� v <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � //aU ��Evs�kJ D�c��vc� <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: G vJ . �S <br /> State License# g(� Expiration Date: <br /> Phone: cell - �{ — office <br /> Mailing Address: �����/� S��j µ�1.4�1 SC2SGf ?,a� City:�/4�(g rD��n1 ZIP: sq <br /> Contact Person: ��yWy � Applicant is: a r / Homeowner (Circle One) <br /> Email and/or Fax: �,��y (� �p2,1DOrJ "�3'�4W�GS. �O v✓) <br /> PROPERTY OWNER INFORMATION: <br /> Name: d � <br /> Phone (day): � • - O <br /> Address: City: ZIP: <br /> Email and/or Fax � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: � � rJ <br /> Phone (day): (p - — ,g � <br /> Address: d t� C urtl: S . Cit : �s ZIP: $$ <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <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&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 /> $ O � <br /> Estimated Construction Valuation (excluding land) '- <br /> / � <br /> Packet Last Updated.� 04/19/2013 ' <br /> Page 22 of 23 <br />