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� � -� � � ,� � <br /> City of Orono �' � ,� �' <br /> Buildin Permit A lication '�'�` 5� <br /> J pp � 2- <br /> for New Structures or Additio � � � <br /> MailingAddress: Permitnumber: 0�01�-Om63� <br /> O�,�,�.0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 7'Z' � Z <br /> ,� a StreetAddress:' Received by: �'' <br /> '�, ° �ti`� 2750 Kelley Parkway Plan review fee: b oZ-OU�O?f <br /> �9gESH�g�' Orono, MN 55356 ,(�,p' <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: L <br /> Job Site Address: �{ „Q S � DI J n r Ci .r <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 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/APPLICANT INFORMATION: <br /> Name: ���i(, 4 rh P � h t.S A✓� <br /> State License# Expiration Date: <br /> Phone: �f S� - `�� �' D 73 g (office) (cell) <br /> Mailing Address: t- e �v��C .2 Cit : o � d ��� G <br /> Contact Person: ' � ;.�a q✓ Applicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: •, Q R ✓' A; C 0 <br /> PROPERTY OWNER INFORMATION: <br /> Name: (�(/� f�,a vyJ t �'►.P -�j Gf�' <br /> Phone (day): � � 2- �-f 7 a- D"73 q �. <br /> Address: ,o g p/r!t � Cit : K q� ZIP: '�5 �� <br /> Email and/or Fax P,'�.e ✓' f <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P: <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 ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with 0'beck <br /> ❑ Relocation � • �� / detached garage ❑ Office/Commercial ❑ Private Sewer <br /> [�'Other: (specify) , �0 n G i2 c �1 ❑ 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) ❑ 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) � ��Q a <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />