Laserfiche WebLink
, � , <br /> / ! 7 U_� <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: pV//v� --� � <br /> O��,�.0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 7�g—/ � <br /> ,� �, StreetAddress:' Received by: � <br /> '�',�, ° GtiiS' 2750 Kelley Parkway Plan review fee: D��-0��� <br /> �9kESHOg� Orono, MN 55356 <br /> Total Fee: � <br /> Main: 952-249-4600 Fax: 952-249-4616 wvvw ci orono.mn us �-� � • �S •— u <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 ;�u.�ava C�i I'c;� <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: �'/'An K(�ti %�<�� 1���S �� � <br /> State License# v�po�� Expiration Date: ,,s?�/s� <br /> Phone: _ 5' -7 office "/ - � ? cell <br /> Mailing Address: �' {rl�'!� Cit : �� > ZIP: /,;/'l <br /> Contact Person: - 4 > > Applicant is: ntrac Homeowner (Circle One) <br /> Emailand/orFax: M,k��jutKsa��j��'nunr'i,,.�,,1��,.�s., ��� <br /> PROPERTY OWNEI�NFORMATION: <br /> Name: ���/c;i l��hrC'� <br /> Phone (day): � ,L— '9 p -����� <br /> Address: �j._$� r�t-�,,,�A,� ��,..¢jn City: �/�sn �} ZIP: ,,r.S�,$�(� <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Add ress: 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 & <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 <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(specify) <br /> MCWD review& permits. ❑ Industrial f�] 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) $ /,,Z OCk) � <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />