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' City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �- d/� <br /> 4.,0,� PO Box 66 <br /> Q Q Crystal Bay, MN 55323-0066 Date received: � <br /> .� f�''��-�" �, Street Address:' Received by: <br /> � 'E,�,y � / <br /> �'�nt� '� p'C�,� �ti 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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �� G? U�/�� �Z�'i� � �t��,.-g-�� <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-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/ ICANT INFORMATION: <br /> Name: � � .-� .�� � henbr�:� �r'rS�� .-�'�J�= <br /> State License# �p���y '�j Expiration Date: '�-- 3/- I � <br /> Phone: - - p�/-7 (office � -- � j�-�,,�c'%,:z cell <br /> Mailing Address: ' _�;,vF€ "R Cit : � �.�;� ZIP: �yl. <br /> Contact Person: �R�.�►-� �Sffp e.��5c�.t/ Applicant is: ontrac / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: � <br /> Name: ___,"'"r�.� v+�-�-��Y /�/ �'�►'�� <br /> Phone (day): ���- �3 eJ— �p 3 S / " L <br /> Address: ��'{�Q ���,1;�}�' jZ}j �,, City:1i>nqG.?-�(�ZIP: <br /> Email and/or Fax <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 ❑ Garage/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 require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial <br /> ❑ 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) $ �' �fl��' -- <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />