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. . �/ <br /> �� �� <br /> � �� <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: O l� !DO/ <br /> g+�.�\ PO Box 66 <br /> Q o\ Crystal Bay, MN 55323-0066 Date received: /O <br /> ���, 1 <br /> � ��s���,,. <br /> �.y��s-�;,,� s,� Street Address:' Received by: <br /> �c�L���;�ll'����, �� 2750 Kelley Parkway <br /> �,h� � Plan review fee: /� <br /> `�kEsxo4`' Orono, MN 55356 �� <br /> Total Fee: Yy� ��� �j�p <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: �w� P <br /> Job Site Address: � �{ gv CO(IrJ 'w �O <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes, a special evenf permit is required wrth Police Department and City Council approva/60 days prior to the event. Shuttle bus service wrll 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: �[ivP� �ui�.fi�,�lvc�y (,0►r,�U✓�t'�"Lf/►�J <br /> State License# a g� Expiration Date: <br /> Phone: �.r2 _r�7�_�, O S�7 (office) (cell) <br /> Mailing Address: ��{3,5- c� 1,0 t Cit � �vi�H- ZIP� ,��c�� <br /> Contact Person: Tp� �K,� Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: C�S2- K7� � �o� <br /> PROPERTY OWNER INFORMATION: <br /> Name: S•c��,,, -�- �Jb �}a.v�s.P r <br /> Phone (day): ��2_y�6_�,� <br /> Address: ��,�j ('�„�,y� ��� ,� Cit � �� ZIP� �3 (� <br /> Email and/or Fax <br /> ARCH(TECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: _ City� 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 detached garage ❑ Office/Commercial <br /> ❑ Private Sewer <br /> �'Other: (specify) �[�}� �p,i,,10G�f� ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ 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) $ ;; $� O�� <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />