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� i <br /> , � � <br /> � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: �� ��� <br /> ��/�,0,�\ PO Box 66 Permit number. ' <br /> , � Crystal Bay, MN 55323-0066 Date received: / <br /> '� �r � // /� <br /> ll�,a �''�,-;'� �,�, Street Address:� Received by: �-d/ <br /> ��'�,n ��, G�� 2750 Kelley Parkway Plan review fee: <br /> \'�R�'"�.�`r 4� � Orono, MN 55356 <br /> �kEsi�o=/ /L/ `�' ��/ <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: `�' ��;, ,'; � ; /� ��f � ��� �� ���� <br /> � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> If yes, a special evenf permit is required with Police Department and City Counci/approval 60 days prior to the event. Shuttle bus service be <br /> required unless applicant demonstrates suffrcient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMA O <br /> Name: �ct c� ��� i•�,���f <br /> State License# Expiration Date: <br /> Phone: - � .�- (.� office <br /> cell <br /> Mailing Address: P � ` � � Cit : ti ZIP: , _�� <br /> Contact Person: ,�. � ' Applicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: `��=' - C� `'-- ` <br /> PROPERTY OWNER INFORMATION: <br /> Name: .�! - � S <br /> Phone (day): L �n G <br /> Address: D e�'f c��'�l� _`�'� Cit : �� �,;,-�� ZIP: � �� � <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: r`l� �� �S�����iJ �iC'C�c�S ' �- i1'l d 1�v;�I�� :_��., ? I I � w •��u�,s <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> � Water Supply <br /> ❑ New Construction ❑ Single Family with �esidence <br /> ddition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> ❑ Other: (specify) ❑ Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "''`Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial <br /> ❑ 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.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ bG�, <br /> ; <br /> , �� , <br /> � , � , <br />