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� � ��_:,i� • �'� <br /> t, City of Orono � �, 7 <br /> � B�uilding Permit Application <br /> � <br /> � � t � <br /> � �, for New Structures or Addit�ons <br /> , <br /> � Mailing Address: Permit number. l��� <br /> /�,O,j�.� PO Box 66 <br /> � � ,� } <br /> Crystal Bay, MN 55323-0066 Date received: <br /> �� �� '� I Received b <br /> `1 a q'�t� ` a,�, Street Address:� y� <br /> ���n � �� �� 2750 Kelley Parkway Plan review fee: � o? . <br /> �V`�'Esi�o�'��� Orono, MN 55356 � <br /> "--- � Total Fee: ��1�—�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: � f - ,,l ' � <br /> Will this be a Parade of Homes, Re delers howcase Home or other Display Home? ❑ Yes [�-PJe-- <br /> /f yes,a special event permit is required with Police Department and City Counci/approval 60 days prior to the event. Shutfle bus service will be <br /> required unless applicant demonstrates sufficient on-srte parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR 1 APPL�ANT NFORM T O : <br /> Name: Cc� � .� � <br /> State License# Expiration Date: <br /> Phone: ( d " �" � ;- ° cell <br /> Mailing Address: r" >< Cit : - ZIP: <br /> Contact Person: a � ,��; Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��� <br /> Phone(day): <br /> Address: ��� SL'�z'i�w�9 � ,�� �c� CitY� �if'G�/SlG ZIP: <br /> Email and/or Fax � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <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 ❑ 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 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) $ <br />