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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions � �;,� <br /> MailingAddress: Permitnumber: •i��-�1•� �f��(�,.`�'� - <br /> O�,�,�.0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �-'�/ � .� <br /> � ,� �' �, Street Address:' Received by: ��� � C' <br /> �'.�, � �ti�' 2750 Kelley Parkway Plan review fee: �;- � , �� � ����������"� '� <br /> r.ykESHog,� Orono, MN 55356 <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 �rr�vw.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: �I j� ��O�G�- <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 approva160 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: ��0 �?Q S o�f �Ji�!��'�q �oM�Un� <br /> State License# C ?Qol Expiration Date: <br /> Phone: S2 ?��-33D office cell <br /> Mailing Address: �22'1'J �Co (� �e Cit : �n ,/, l� ZIP: S j3 <br /> Contact Person: i ( a,�.Fo� Applicant is: on�rac or / Homeowner (Circle One) <br /> Email and/or Fax: u ff,•�vqly C� � C� <br /> � <br /> PROPERTY OWNE INFORMATION: <br /> Name: � ,a� � �rtQ Tre�wu <br /> Phone (day): Z►5O rOD (�- �p <br /> Address: Cit : ( � ZIP: �f✓',3� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: �{ "�' <br /> Name: <br /> Phone (day): <br /> Address: City: 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 /> New Construction ❑ Single Family with ❑ Residence <br /> Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building � Single Family with �Deck (1��!,.; �� L <br /> ❑ Relocation detached garage ❑�ffice/G`ommercial ❑ 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) $ y'��O <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />