Laserfiche WebLink
� <br /> � <br /> ' CITY OF ORONO �� <br /> � BUILDING PERMIT APPLICATION <br /> �o� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> O Mailing Address: � Permit number: ���'��D� <br /> g- �O PO Box 66 �� <br /> Crystal Bay, MN 55323-0066 � Date received: �j� —/� <br /> Street Address:' <br /> ��- ,"1�'�� Received bY: - <br /> y� ��'' 2750 Kelley Parkway �� Plan review fee: ��J- /O � <br /> t L Orono, MN 55356 8 <br /> q'�FSH��� ✓ COJ�� I <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 /> Incompiete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: o��-� ����� � <br /> Will this be a Parade of Homes, Remodelers Showc e Home or othe Display Home? ❑ Yes � No <br /> If yes, a special event permit is required with Police Department and City Council approva160 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events wiH not be allowed. :$ <br /> CONTRACTOR/APPLICANT INFORMATION: 1 :i <br /> Name: ���� �o/`r�.h/<�.N �O.Nc7�"'lYx:7-i��tJ Zs1�C= � <br /> State License# ,�G �',"Q�� Expiration Date: ' �/t� <br /> Phone: cell office -9, �- �' <br /> Mailing Address: Cit : ,�; " ZIP: <br /> Contact Person: Applicant is: ontra / Homeowner (Circle One) <br /> Email and/or Fax: ' - ► . �1/ 9 3�- <br /> :;� <br /> PROPERTY OWNER INFORMATION: <br /> Name: � l yctr'/`�7'11a,�'1. <br /> Phone (day): <br /> Address: � y g ����,� �� City: ��.v� ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ;�� �, ,� ' , C� <br /> Phone(day): -.� - `'�� <br /> Address: J 1 3H�' /�v rU Cit : S ZIP: p�� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <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 attached garage (aGarage/Accessory 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 also require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ M1 thef: (speC fy) _ <br /> 18202 Minnetonka Blvd � �,rct � <br /> Deephaven, MN 55391 � <br /> Phone: 952-471-0590 "� <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ���, �p� ' <br /> � <br />