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� <br /> f • ' <br /> Buiiding Permit Application #����l� <br /> City of Orono <br /> D E N uilding Permit Application <br /> IEC� <br /> Reas tordenia�: r New Structures or Additions <br /> Maifing Address: Permit number: �'��� <br /> � O Box 66 <br /> St � � � rystal Bay, MN 55323-0066 Date received: �b o2 /O <br /> � Date: � /(� <br /> ,� t �--?' �, et Address:� Received by: "1'� <br /> �, � �r;��' ti <br /> �,t���`,� °ti 2750 Kelley Parkway Plan review fee: <br /> 9kESHo�'� 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: �������,� ��� �� 54YE'E'� <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/AP LICANT INFORMATION: <br /> Name: � �-C— � �5��!�i�9 <br /> State License# 7�,�/ Expiration Date: <br /> Phone: / QO �/7 S 5 3� 3 (office) (cell) <br /> Mailing Address: �j� /�J� �y��y�,�jti,� G�y��u� City: �-�'-,��/ec/ �GG'/ ZIP:�'�/1�;�' <br /> Contact Person: �i.AKC Applicant is: Contractor Homeowner (Circle One) <br /> Email and/or Fax: � - �f� ��� 1;� <br /> PROPERTY OWNER IN ORMATION: � <br /> Name: ��C(�'l/'L C� '' �c�t� <br /> Phone (day): .-�`"� - -�{� � G''Y' (ci Z - �J2-W 5 � <br /> Address: � ��( -= (�.�-`j/y Cit : l;'�Gti1CU ZIP: r5�s� <br /> Email and/or Fax tYCd��1 c���C�ea,ry�s%�.�s .��"yy'� <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: �j,r�ry�� <br /> Phone (day): <br /> Address: City: ZI 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 ❑ Residence <br /> ❑ Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation ; ��o d� detached garage ❑ OfficelCommercial ❑ 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 /> Estimated Construction Valuation (excluding land) $ ,'>jQ,D�D <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />