Laserfiche WebLink
. • " , - <br /> . CITY OF ORONO J (D.�s <br /> � 52 <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O MailingAddress: Permitnumber: ����-�QZ�"j <br /> PO Box 66 <br /> � �� Crystal Bay, MN 55323-0066 Date received: <br /> - StreetAddress:' Received by: �� <br /> y� G''' 2750 Kelley Parkway ���U��{,� Flan:!review'fee: `# ,� -2o y-DoZ$� <br /> �; Orono, MN 55356 <br /> �"��ESFio�` Totai Fee: I <br /> Main: 952-249-4600 � Fax: 952-249-4616 www.ci.orono.mn.us _ i <br /> This application.form must be completed in fulf and all requiretl�information musf be submitted: i <br /> Incomplete appiications will be returned: (Please print) i <br /> GENER INFORMATION: <br /> Job Site ddress: .� I <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ❑ No I <br /> lf yes,a special event permit is required with Police Department and City Council app�ova!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/APPLICAN R TION: � <br /> Name: =a� <br /> State License# Expiration D te: <br /> Phone: cell • • office • • I <br /> Mailing Address: Cit : ' P: <br /> Contact Person: W• E pplicant is: ontrac o / Homeowner (Circle One) � <br /> Email and/or Fax: � i <br /> PROPERTY OWNER INFOR�I N: <br /> Name: <br /> Phone (day): • � � ,� ,� <br /> Address: Cit : �VJ�A ZIP: J 3 <br /> Email and/or Fax • <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: !SA ��M 'E la1 S C.D w f K�k �.TC1 tl�... I <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 /> ew Construction ❑ Single Family with esidence <br /> ❑Addition attached garage ❑ Garage/Accessory Bidg. �ublic Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation ,�etached garage ❑ Office/Commercial ❑Private Sewer , <br /> ❑ Other. (specify) !!�J Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage Public Water I <br /> **Any earih movempn4 may ais� �aGu�re ❑ Commercial ❑ Other(specify) � <br /> MCWD review&permits. ❑ Industrial , ❑ Private Well j <br /> Minnehaha Creek Watershed District(MCWD) ❑Other: (speClfy) i <br /> 18202 Minnetonka Btvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 I <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or I <br /> ��s� D�v — , <br /> Estimated Construction Valuation (excluding land) $ / � ; <br /> � � <br /> 3 � <br /> � � <br /> � <br /> ji <br /> � � <br />