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� <br /> City of Orono <br /> � <br /> - Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: o��.�c�- C < <-�' 3�S"' <br /> O�,�,�.0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: l C.> - ��' � � Z' <br /> A J�� �c��l:;��f Received by: �� . �} _ y-�J� ' � <br /> a �.�, �, Street Address:� , � <br /> �`,�, Gti`S' 2750 Kelley Parkway --- �f Plan review fee: '�j ' ��� -V�`� <br /> L'�'Esxo4`� Orono, MN 55356 <br /> Total Fee: . �g -JN- . l�-/ <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: <br /> Job Site Address: 2� �� ���� a�� <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/APPL ANT IJaIFORMATI :/� �� <br /> Name: be,�►r <br /> State License# Expiration Date: ZO <br /> Phone: 2 7 �f v office t ZSD /d O cell <br /> fVlailing Address: /3 : � Cit : ZIP: 4 <br /> Contact Person: plicant is: Con ractor / Homeowner (Circle One) <br /> Email and/or Fax: ,e, � �,�, r� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ,2/+r r S t <br /> Phone (day): ' .- .- s2+/ <br /> Address: Z�o tr0 S !� Cit : � ZIP: -�j� 3� <br /> Email and/or Fax <br /> ARCHITECT/EIVGIN R�1 FOR TIO�: <br /> Name: t ti ✓' <br /> Phone (day): .- `t�j a- Z <br /> Address: City: ZIP: <br /> Email and/or Fax: <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 esidence <br /> �dition attached garage ❑ Garage/Accessory Bldg. [�ublic 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 /> O� <br /> Estimated Construction Valuation (excluding land) $ ?j0, /4�/ <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />