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Cit of Orono �`��° <br /> Y <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: ,.�; � <br /> 'g.+�.� PO Box 66 Permit number: � �—L;/ C --�;�' �? <br /> Q h\ Q Crystal Bay, MN 55323-0066 Date received: � (o � �� <br /> � � <br /> � ������:����. ��� Street Address:� Received by: �� �� <br /> c��� �i�� ��� i 2750 Kelley Parkway Jd (/i SI4 g/G �'7 , �r"j' �'��' ` <br /> t �` � Orono, MN 55356 / Plan review fee: 2. � - , �c� <br /> kESH�4 <br /> Total Fee: � � � �� n <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us ,��1 <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 �, <br /> Will this be a Parade of Homes, Remodelers Sh case Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a specral 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 /> State License# E piration Date: <br /> Phone: o ice ' - Z�j' cell) <br /> Mailing Address: Q ` Cit � .� � ZIP: C{' <br /> Contact Person: Appl�can i : ontractor / Homeowner (Cirde One) <br /> Email and/or Fax: � <br /> PROPERTY OWNER INFORMATION: ,{� �1 � <br /> Name: /` I'�7�-� SW�t/LS��I <br /> Phone (day): <br /> Address: _ City� ZIP� <br /> Email and/or Fax <br /> ARCHfTECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City� Z�p� <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 Construction ❑ Single Family with ❑ Residence <br /> ❑Addition � �,�4}'V`�� attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building�,�E��E r � .��-�� c ❑ Single Family with Deck <br /> ❑ Relocation �c � ck�;tc detached garage ]�ffice/Commercial <br /> ❑ Other: (specify) � ❑ Multi le Famil /Condo ❑ Private Sewer <br /> P y ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "'`Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑ Private Wel� <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 � a <br /> Estimated Construction Valuation (excluding land) $ <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />