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- �� . . � � o� . �s <br /> . � � <br /> � City of Orono <br /> Building Permit Application � ,� <br /> � ��� <br /> for New Structures or Additions � <br /> �—= Mailing Address: a�f��. {j(,�7 <br /> '�,L,�,� PO Box 66 <br /> Permit number: <br /> � � � ,1 Crystal Bay, MN 55323-0066 Date received: � .�— <br /> ���3 . <br /> a `�'�y��`' s. � StreetAddress:' Received by: <br /> R�,Q_., <br /> �'�,n � 4 '"� �ti 2750 Kelley Parkway Plan review fe /�— � � <br /> L�sg��.g,*v Orono, MN 55356 <br /> Esx � <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: r�-�' <br /> Job Site Address: �J ��J � l� � �(�� 1'1U "��3� l <br /> , , <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Displ y 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. Shutfle 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 INF RMATI N: <br /> Name: �� ������e,,G.�j'�v"l <br /> State License# �� ti��]� � Expiration Date: '3•-3/i� <br /> Phone: �' office ' � z - , �� (cell <br /> Mailing Address: � � Cit : / � � t��r ZIP: <br /> Contact Person: � �� S� Applicant i . Co acto / Homeowner (Circle One) <br /> Email and/or Fax: „� - � �z,, ry ��o ��- 1f <br /> PRGPERTY OWNER INFORMATION: � <br /> Name: `� )c'i'�� C��� � ��ZS`(� ��(� 1�'��� � <br /> Phone (day): , j , _ <br /> Address: ` � Cit : D'�;yt ZIP: c ` <br /> Email and/or Fax ' � , � <br /> i �- <br /> ARCHITECT/ ENGW R 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 8 <br /> Water Supply <br /> ❑ New Construction �Single Family with ❑ Residence <br /> Addition attached garage arage/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(speci ) <br /> MCWD review 8� permits. ❑ Industrial �,t.°I n�2: �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) $ .. � <br /> Last Updated: 4/26/2011 �f/ <br /> - 19 - �1i�� ��'�'�. �Cs <br />