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. <br /> . <br /> / gO� 1 � <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> �Q,O� Mailing Address: Permit number: ��0"�d�� <br /> PO Box 66 <br /> Q �\ 0 Crystal Bay, MN 55323-0066 Date received: ,� �� <br /> 'Af?i�4�T� � <br /> �� t�§'����-4-��.'� s, Street Address:' Received by: <br /> �� �N'pe��� G�F 2750 Kelley Parkway Plan review fee: <br /> t�, � / <br /> `9IfESKp4�'�' 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: �� �h,���� � �'/2. /� <br /> Will this be a Parade of Homes, Remodelers Showcas Home or other �splay Home? ❑ Yes o <br /> lf yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service wil/b <br /> required unless applicant demonstrates sufficienf on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: � � .��C <br /> State License# Expiration Date: Q, �b/� <br /> Phone: — 7 j office (cell <br /> Mailing Address: � Cit : ZIP: 3S <br /> Contact Person: Applicant is: Contra or / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION:. ,� <br /> Name: �(/���_�p� J��'���� <br /> Phone (day): <br /> Address: City� ZIP� <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: _ Cit � ZIP� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & <br /> ❑ New Construction Water Supply <br /> ❑ Single Family with ❑ Residence <br /> ❑ Addition attached garage ❑ Gara e/Accesso Bld <br /> ❑ Accessory Building /� ��— ❑ Single Family with ❑ Deck9 ry g' � Public Sewer <br /> ❑ Relocation rl `� detached garage ❑ Office/Commercial <br /> f��s�� ❑ Private Sewer <br /> �Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> �tq�/� ❑ 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 /> Estimated Construction Valuation (excluding land) $ -��---- <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />