Laserfiche WebLink
, �, �, �� � <br /> . . �� g �� <br /> ��3 <br /> City of Orono <br /> Building Permit Application �� � <br /> for New Structures or Additions � 1 <br /> Mailing Address: Permit number: O1� � - �(� p <br /> Q PO Box 66 <br /> � �` �Q\� Crystal Bay, MN 55323-0066 Date received: � �� <br /> / � <br /> I � StreetAddress:' Received by: � <br /> ��,,`' ;,� 2750 Kelley Parkway Plan review fee: 7 Z, <br /> � Orono, MN 55356 Q�Q� -O b�( 7 <br /> O9Ktswo�E Main: 952-259-4600 Total Fee: <br /> �--- <br /> 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: Z S��C: (�;�`�` c'_ l� , C'rG'�t.d Mh% <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> !f 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/AP LICANT INFO(�MATION: <br /> Name: Gi.�►1 �r(,c.�c�L����.l�GLL <br /> State License# � Expiration Date: <br /> Phone: cell office � � " <br /> Mailing Address: �`TZ ^ y �, Cit : ` �'��LS �� ZIP: . ' � '?,�t S <br /> Contact Person: Applicant is: Contractor Homeown ' �c���ie o�e► <br /> .. <br /> Email and/or Fax: h : (_�,�� Z.L�-��j 3�"LS <br /> PROPERTY OWNER IjJFORMATION:g -� �� � v ►`'f—�� <br /> Name: ��(,,�piWLlr r.� GLt�-al I��i.PS h ('�-' <br /> Phone (day): G .. , �� � �• .�3�� �S 74:•�� <br /> Address: S � '.'� Cit : i��� ZIP: ��� �S�- <br /> Email andbr Fax 3 5 � � �- i�� ce.�- - � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <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& <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑ Residence Jt���1 <br /> ❑/lddition attached garage Q�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 8�permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) <br /> 18202 Minnetonka Blvd °��y��-p�,:.,� ' <br /> Deephaven,MN 55391 �L,�,i n��i.kYl�I►�JZ <br /> Phone: 952-471-0590 �" J <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ S�}-, C�C <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />