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�� s � 71� <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: 00/0—40 3 3 y <br /> O �O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' Received by: <br /> Kelley 2750 <br /> Y Parkwa Y Plan review fee: <br /> `�kEsso4` 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: S +5 wl How Dr- <br /> Will <br /> rWill 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/APP (CANT INFORMATION: <br /> Name: i[,J-P, �Su A c�e� <br /> State License# Expiration Date: <br /> Phone: 2 (o3 --5"0(-,— G 2G (office) (cell) <br /> Mailing Address: Cit ZIP: <br /> Contact Person: Applicant is: Contra or / Homeowner (circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: gg�& <br /> Phone (day): _,rckSLt--1-7 000 CA <br /> Address: — S L{C, L'J',�`Ouj PR�we.. S00-� City: ©�pIJC� ZIP: <br /> Email and/or Fax R=oU) LO'k <j,,Ae9\ 2 Ga' �;,,`c�l�— ,Cp1n•� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: fly: ZIP: <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 /> ElNOW Construction E] Single Family with ElResidence <br /> Addition attached garage ,0 Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> El Other: (specify) El Private Sewer <br /> ( p fy) ❑ 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) O her: (specify <br /> 18202 Minnetonka Blvd ASA&-z- <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 /> Last Updated: 9/29/2009 <br /> - 17 - <br />