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City of Orono <br /> . ' Building Permit Application <br /> ' for New Structures or Additions ���S�r� su►- v�- `s <br /> Mailing Address: Permit number: ���� �!i��(v <br /> O��,�.0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �'7 a /a <br /> a StreetAddress:' � _. Recei�ed-�y: /��� �� <br /> � titi 2750 Kelley Parkway �`"`T CC' P _[e�ri�w_fee: `� ( 7a • 5�' <br /> G <br /> t•�q.�Ho�.'� 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 INFORMAT O I <br /> Job Site Address: �� 5���- l�-�c (1 <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 demonstrafes su�cient on-site parking is available. Non permitted events will not be allowed. <br /> CONTRACTOR/ PLICANT INFO ATION: / <br /> Name: L,-L.--L <br /> State License# Expiration Date: <br /> Phone: .- -- office ell <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: a, Applicant is: Contr ctor / Homeowner (Circle One) <br /> Email and/or Fax: v � <br /> PROPERTY OWNER INFORMATIO� <br /> Name: ��,qS�tc.� S <br /> Phone(day): �J� ��O- $�{'�-� <br /> Address: �-�,� s��� 1�c�, City: (�,�j ZIP: ��,5� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: �� <br /> Name: �� �-�ev�Ce_ ��o•-L <br /> Phone(day): -q - -� <br /> Address: �too� ��,.�,� S - City:�LiN.�.� ZIP: 5��3 S <br /> Email and/or Fax: 15�--.�j�,�_L��.c� <br /> 9� <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposat& <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 ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> �ther: (specify) � ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> `*Any earth movement may require ❑ Commercial ther(s ecify) <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) $ �� dc9� <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />