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(, • \� <br /> ��� City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: ��� _�77 <br /> .���0 PO Box 66 Permit number: _ <br /> Crystal Bay, MN 55323-0066 Date received: '� <br /> StreetAddress:' Received by: <br /> y � 2750 Kelley Parkway Plan review fee: <br /> F �` Orono, MN 55356 <br /> l�kESHO�� Main: 952-259-4600 Total Fee: �O� p�. �p 9 <br /> FaX: 952-249-4616 ��rw�v c� ��ion�� iiii� u� <br /> This application forrr� must be completed in full and all reyuired information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � 2� C� �0 �, <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/APPLICANT INFORMATION: <br /> Name: v-;�--,�- n���.\� <br /> State License# Expiration Date: <br /> Phone: cell � 2 � 't s��� office <br /> Mailing Address: '?�Z � , a �N Cit : ro._...� SJ 3(, <br /> Contact Person: 5�,�,�� Applicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: SS-�, z <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> F'hone (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 8 <br /> Water Supply <br /> �New Construction j�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 ❑ 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) $ l�U � , 0 v <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />