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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: 0l0(3- b f� <br /> j/�►„D,j�. PO Box 66 <br /> ,� \ Crystal Bay, MN 55323-0066 Date received: 'J' 3 <br /> j��,a �"��t��r <;� a.l, StreetAddress:' Received by: � S hn�.f �,, <br /> ��',�, ��� ��/ 2750 Kelley Parkway Plan review fee: <br /> �'�q"'�• ��'�� g,� Orono, MN 55356 <br /> kESKo /`7`� �J <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. (P/ease print) <br /> GENERAL INFORMATION: � ; � <br /> Job Site Address: /�/� `S�j�/�l.�t�c>�;� ���,�-(� �L�1,��1��i;c 1 <br /> Will this be a Parade of Homes, Remodel Showcase Home or other ' play 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 INFORMATI(�N: <br /> Name: ,Ci� �i� � '�io; <br /> State License# �� �/o.�i�,/ Expiration Date: �3/ � <br /> Phone: (office) �/,�-�ogy-y�y7 (cell) <br /> Mailing Address ��,� • Cit : "—' , � ZIP:�TT ;r� <br /> Contact Person: �� . Applicant is: on rac� Homeowner �c���ie o�e� <br /> Email and/or Fax: - / � � i � :� � ;/ �;i <br /> PROPERTY OWNER IWFOkMATIQN: , _ � <br /> Name: �r���i� � �Gr�/✓ �i�fZc�L��'i��� <br /> Phone (day): q,s;�_ y7/_ 7yy"� p <br /> Address: � �� �w�� '��� City: L� /ZQ,� ZIP: ,-�"j',��-�J� <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/Ac,essory 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 ❑ 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 /> � � <br /> Estimated Construction Valuation (excluding land) $ �� � <br />