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/ � . <br /> , City of Orono �j � <br /> Building Permit Application ��2 <br /> for New Structures or Additions <br /> Mailing Address: � <br /> O�,O,�.O PO Box 66 <br /> Permit number: 7—L <br /> Crystal Bay, MN 55323-0066 Date received: �� v� /Z- <br /> ,� �, Street Address:� Received by: � L� <br /> �`,�, Gti�' 2750 Kelley Park ay ����„�`�� Plan review fee: �� �` <br /> ��ESH�4'� 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 INFORMATION� �� �����i fi j �v� <br /> Job Site Address: �� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes, a specia/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 I A LICANT INFORMATION: �� <br /> Name: �'�. (� `c,.cc �� <br /> State License# Expiration Date: <br /> Phone: �— �Q��K office �,�� �`(�"�(` (cell <br /> Mailing Address: t �cr� v�-� Cit : ZIP: <br /> Contact Person: � =2. Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: � ���--�� . �l � , <br /> PROPERTY OWNER INFO�ATION: <br /> Name: �:;� t�,�Sc�i� <br /> Phone (day): <br /> Address: , �ST� �wt�� — City: L��-L,� ZIP: <br /> Email and/or Fax ^ <br /> Name:ITECT/ EN,GTIN�ER IN��-��c�s.�p��'`��'��'�� l �``� l�h,� �S�1�� " '7��S� <br /> 1 <br /> Phone (day): <br /> Address: City: ZI P: <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 esidence <br /> ❑�ddition attached garage Garage Accessory Bld . ❑ Public Sewer <br /> �'Accessory Building ❑ Single Family with Deck <br /> ❑ Relocation detached garage ❑ Office/Com ercia 'l ❑ 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 <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ V�� �� <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />