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City of Orono <br /> � Building Permit Application <br /> for New Structures or Additions <br /> —_-_ Mailing Address: Permit number: D(��0 �2� , l' <br /> //.¢,�,�� PO Box 66 <br /> /O, t, O Crystal Bay, MN 55323-0066 Date received: /O" zD–�� <br /> Ij �x# '� } Received by: ��s <br /> ` „ +�{�� _ ,, , StreetAddress:' <br /> \'��,t� ��,��� ��/ 2750 Kelley Parkway Plan review fee: o� D l�–'D l 2..7 q <br /> �A�..�.�, 4,� Orono, MN 55356 303.�1 � CG <br /> �,,,�sxo, � <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: �� S� " U� ,�/�- <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 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 will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATIO <br /> Name: �in,-,,��f ,��5 <br /> State License# Expiration Date: 3 - /- 20/Z. <br /> Phone: 5 0 9 S� office �/ - Zo -/�y cell <br /> Mailing Address: s c�,�n ���� Cit : ;rr ZIP: ,$�30 <br /> Contact Person: v i ; Applicant is: ontractor y Homeowner (Circle One) <br /> Email and/or Fax: sf�� � �,�n1•r.�,sli �1 + /�rr5 � co �n �63 �/�7 y.3�2- <br /> PROPERTY OWNER INFORMATION: <br /> Name: /�SS ���- <br /> Phone(day): � � 70 <br /> Address: S c�—6 .�+�`+G City: ��14rIG' ZIP: ,�J' .5.�5^�_ <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 INFORMATION: <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 eck <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 �-Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Othef: (speCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> wwvd.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �Q O�a <br /> � <br />