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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: <br /> '��,�,j�.� PO Box 66 <br /> /Q „ \ Crystal Bay, MN 55323-0066 Date received: <br /> � �s;,, � <br /> �"�� '�'� � Received by: <br /> ,� ,���.{��.i;� �, , Street Address:� <br /> �',F, �� ''�� ti 2750 Kelley Parkway Plan review fee: <br /> �9kE$H�4'�'G Orono, MN 55356 <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: L I'�-t C c ,,-, �' � � ' ` ; ..� i� °-- -- "(,� <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: ` <br /> !��;,n I "5 ���kc... n�s <br /> State License# 2�� �j�=, 1t��� Expiration Date: ���z��/Z�, i <br /> Phone: �ti7_-��� - `j�[o r (office) �+z.;e�c��� (f%17-Z72- �3�y (cell) <br /> Mailing Address: '� �f ,� Cit :__ - �a- ZIP: <br /> Contact Person: �}��` LL��� Applicant is: Contract� / Homeowner (Circle One) <br /> Email and/or Fax: ��" (,i k_;v�I,l:�•, c r.b:� ��I. c c�-� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��jo���ji;-� <br /> Phone(day): �SZ - y�3 -��S��i <br /> Address: Z I�i O �c,Le�� C v�.�t- City: L?��,��, ZI P: �� �.���L_ <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: <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) �L.P - f u;:-� ❑ 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.m i n n e h a h a c re e k.o r <br /> Estimated Construction Valuation (excluding land) $ ZZ, GC:�C� <br /> Last Updated: 9/29/2009 <br /> - 17- <br />