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�'� �`� <br /> � Cit of Orono � <br /> y � � , <br /> Buildin Permit A li � <br /> g pp cation <br /> for New Structures or Additions <br /> �—� Mailing Address: Permit number: � C� -d�(�� <br /> 4v�� PO Box 66 <br /> Q �,, � Crystal Bay, MN 55323-0066 Date received: � / �D/d <br /> .� �`��'�?,�4:::;,� s,) StreetAddress:' Receivedby: <br /> �'�n�����.�,� oti�' 2750 Kelley Parkway Plan review feE;: <br /> �kESH 4� 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. (P/ease print) <br /> GENERAL INFORMATION:�. /� <br /> Job Site Address: • J , ` <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 e <br /> repuired unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLI�`NT INFORMATIO�j <br /> Name: (7�1v�11 �,✓,,�-,.� U s;�/� !�� <br /> State License# �����t�` Expiration Date: �3 — ,�j�� <br /> Phone: office <br /> Mailin Address: � � U (cell <br /> 9 Cit : ZIP: <br /> Contact Person: A plicant is: Contr ctor / Homeowner (Circle One) <br /> Email and/or Fax: �4 - <br /> PROPERTY OWNER INFORMAT ON: �' <br /> Name: � � J` / <br /> Phone (day): — � <br /> Address: � Cit : ZIP: <br /> Email and/or Fax - � <br /> � <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 /> ❑ Accesso Buildin g rY 9• ❑ Public Sewer <br /> ry g ❑ Single Family with ❑ Deck <br /> ❑ Relocation L detached garage ❑ Office/Commercial �Private Sewer <br /> ,�Other: (specify) O� ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public <br /> "*An earth movement ma re�� ❑ Commercial � Storage ❑ Public Water <br /> Y Y q ❑ 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 />