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� - <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: ��C�"�/� <br /> '¢�.� PO Box 66 <br /> Q �; 0 Crystal Bay, MN 55323-0066 Date received: � / ��/c.� <br /> � �e <br /> � '4;�=, � Street Address:' Received by: <br /> � � ' �'�'��, � 2750 Kefley Parkway <br /> Plan review fee: <br /> �rgkESH04�'~ Orono, MN 55356 <br /> Total Fee: �3�. ��� <br /> Main: 952-249�600 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 wi be re rned. (Plea pri ) <br /> GENERAL INFORMATION: --� ' <br /> Job Site Address: -� <br /> Will this be a Parade of Homes, Remodelers Showcase Ho ' r 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 rs available. Non-permrtted events will not be allowed. <br /> r <br /> CONTRACTOR/APPLICA T INF MATION: / � <br /> Name: � � <br /> State License# � Expiration Date: — <br /> Phone: �� • t ffi (cell <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One� <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City� 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: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4, Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Consfruction ❑ Single Family with ❑ Residence <br /> ❑ Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with � eck <br /> ❑ Relocation detached ara e <br /> ❑ Other: (specify) g 9 ❑ ffice/Commercial ❑ Private Sewer <br /> ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "*Any earth movement may require ❑ Commercia� ❑ Other(specify) <br /> MCWD review 8�permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) �- <br /> 18202 Minnetonka Blvd �iG �(y� ����(� ' - <br /> Deephaven, MN 55391 M <br /> Phone: 952-471-0590 � �� /�'�(,V f U ��i <br /> Fax: 952-471-0682 � ,�J <br /> www.minnehahacreek.or �° <br /> Estimated Construction Valuation (excluding land) $ <br /> Last Updated: 9/29/2009 <br /> - 17- <br />