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�• <br /> . <br /> � City of Orono <br /> � Building Permit Application ��9 � <br /> for New Structures or Additions <br /> Mailing Address: <br /> ��Q A;\ PO Box 66 Permit number: O�S' O 1 37 <br /> � `V� ��, Crystal Bay, MN 55323-006 Date received: ��� � � � <br /> (` � � i Street Address:' \`� Received by: C-'�v 1 <br /> ,�f h f 2750 Kelley Parkway �\1 1 YJ Plan review fee: ��S-v/J� 7 <br /> �` � Orono, MN 55356 ��/ �r� <br /> �qh"F s ri����� Main: 952-249-4600 / <br /> Total Fee: <br /> �`"� Fax: 952-249-4616 www.ci.orono.mn.us -� , + ^ - 1f � �'• �' <br /> This application form must be completed in full and all required information mus e submitted. -- <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: '��0 �C,.n� R� <br /> Will this be a Parade of Homes, Remodelers Sho case Home or other Display Home? ❑ Yes g No <br /> If yes,a specia!event permit is required with Police Department an City Council approva/60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �/G���'d X ��y�G�.-:,Ci <br /> State License# Expiration Date: <br /> Phone: _(cell) 6 � ��,/ S (office) <br /> Mailing Address: �.? b �' ,E,v Cit : �.�L�,vb ZIP: ��34' <br /> Contact Person: Applicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: /�/c�A,�d w ��QG��i� i'`i�s,c.v �� �ll/i� <br /> f—, Count►�/Cu rd me.c.6w► <br /> PROPERTY OWNER INFORMATION: , 7 � � <br /> Name: !c/��.Nr"��i� �,)lS0<_K/ <br /> Phone(day): �i,Z-�.b'J- S��a. <br /> Address: -Z,�7 7o j2,+4/,�l F'y �,� City: ��6/V�� ZIP: `� � �� <br /> Email and/or Fax �;i�:l.�f?,c;t7,�,,,y��o�,j��n r/5 .C���T <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with �Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ❑ Public Sewer <br /> �Accessory Building � Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family!Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> "*Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review�permits. ❑ tndustrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) ❑ Other(SpeCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �'� � �J <br /> Packet Last Updated: August 2015 <br />