Laserfiche WebLink
City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> -�— MailingAddress: Permitnumber: ��` — �,�j <br /> ����,�.��\� PO Box 66 <br /> ��0 r ���� Crystal Bay, MN 55323-0066 Date received: ��l—1 �— <br /> �"'�'`� Received b <br /> �'�'� �I Street Address:' y� <br /> ��'� � s, ., _;. a;� / <br /> ��',�, �,���� °/ 2750 Kelley Parkway Plan review fee: 5/ <br /> �� ���� �� Orono, MN 55356 �� � _ 3 <br /> �\xESFIO���' l (SQ ,� <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: � `��i'S �, �� ��� f U�"��-L <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �f�lo <br /> li yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service w�ll be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitfed events will not be allowed. <br /> CONTRACTOR/APPLICANT INFO ATION: I <br /> Name: )G �vti tt� ��c�c�.. – ���ST���"c � . �..-�� <br /> State License# d �3 Expiration Date: � 2b 1 <br /> Phone: � �" '� office ' � Z� Z ��- cell <br /> Mailing Address: U U (��� �;-3 c�..�.� .- Ci : I c�,vi ZIP: 3 <br /> Contact Person: T „ Applicant is: Contractor I Ofll@OWCI '(Circle One) <br /> Email and/or Fax: �o f v��,v�S.� vt.c� c� � �c�--�--�-KS�". �� a.��- -- <br /> PROPERTY OWNER INFORMATION: <br /> Name: �. .�_- �.� �L�� �k� �C%-vt. <br /> Phone(day): � r Z � ,Z � � n <br /> Address: �'j � ; �(J,v Ci : ,v�U ZIP: — ,(� <br /> Email and/or Fax � c%rq ,z� �. �( ( . �q S�'–� .i�,��,�, ���} . �_ «, <br /> ARCHITECT/ENGINEER INFORMATION: l <br /> Name: ��.�.�. �� (� S I�, , E �.�'. (�,�-..� �1�N1�•L a �SOG, / <br /> Phone(day): i Z �L � — <br /> Address: � ,L, � � Ci : S�r�<<a1 �.�:�u��: �S Z <br /> Email and/or Fax: � ,,� � , �,t,� " <br /> c <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <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 � '�6eck <br /> �'Relocation detached garage L,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 J�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) $ �1�, 3 U�' <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />