Laserfiche WebLink
, J • RECE[VED <br /> APR282011 <br /> City of Orono <br /> C�TY OF OR�FVp <br /> Building Permit Application <br /> for New Structures or Additions <br /> ;O_� MailiPO Bo�r66 Permit number. �����1• U�G�--��'/ <br /> �Q� �O� C rystal Ba y, MN 55323-0066 Date received: �� Z-� �o� <br /> ;`` -_ <br /> �� � _,.,�� �I Received by: ��-� � <br /> Street Address:' <br /> �"�',�c, � �� � ��� 2750 Kelley Parkway Plan review fee: <br /> �l.qk�S�J�� Orono, MN 55356 � <br /> _ Total Fee: ��S, G j� <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: �� SMr4D�j1��0�..� �o�c1� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or 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-sde parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: r"�(�p��) ���1pDEL�11� <br /> State License# ZO 5�32.. Expiration Date: 3�3�-t L <br /> Phone: LSI- 554— l23 office) cell) <br /> Mailing Address: IS 11•�— Cit : . . ZIP: 55'p'1 <br /> Contact Person: 5 W�j E Applicant is: ontracto / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNE�NFORMATION: <br /> Name: H�"A) 1� <br /> Phone (day): (o Z Q '� �t <br /> Address: � Cit : (VD ZIP: �✓3�� <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 tNFORMATION: <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/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> �Relocation `-, ;��, A'� detached garage ❑ Office/Commercial ❑ Private Sewer <br /> Other: (specify) WINDb�I �4'�^ ❑ Multiple Family/Condo ❑Warehouse <br /> IM+GrfC'� ❑ 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 e,. <br /> Deephaven,MN 55391 +Ic ��`O �� � '�" W�hQQ�,�)".a rVbO� <br /> Phone: 952-471-0590 '�'��+�.�G <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or ��� t ��11�1 �QE���►S <br /> Estimated Construction Valuation (excluding land) $ f S��aa�- <br /> Last Updated: 12/21/2010 <br /> - 19- <br />