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City of Orono <br /> � Building Permit Application <br /> ` for New Structures or Additions <br /> Mailing Address: Permit number. ��� 'd d� (�' <br /> O.�D,�.O PO Box 66 � <br /> Crystal Bay, MN 55323-0066 Date received: <br /> a� ���� �, Street Add►ess:� Received by: <br /> '�, 4 Y%. �titi 2750 Kelley Parkway Plan review fee: ' <br /> �.q�.�Ho.¢*Y Orono, MN 55356 , <br /> = Total Fee: �%�f , ��.j <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us /Lx� , <br /> This application form must be completed in full and all required information must be submitted. �, i�+ i,�,�`Y'� �� '�;'��i <br /> Incomplete applications will be retumed. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � �v�/�S {Zo� <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�quired with Police Department and City Counci!approval 60 days prior to the event. Shuttle bus service will be <br /> required uMess applicant demonstrates sufBcient on-site parking is available. Non-permitted events will rrot be allowed. <br /> CONTRACTOR/APPLICANT INFO TION: ��� <br /> Name: <�;�.�'. �'`��',t' �"�/ ��,C� <br /> State License# --� Expiration Date: <br /> Phone: � - '"'� office cell <br /> Mailing Address: �"' ` Ci • ZIP: <br /> Contact Person: � � Applicant is: Co tor / Homeowner �ci�a,e� <br /> Email andlor Fax: �; � � - <br /> PROPERTY OWNE NFORMATION: <br /> Name: " 7` ��-�- <br /> Phone(day): , �— -3-� --� <br /> Address: Ci �. �.. ZIP: <br /> Email and/or Fax �L <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 /> f�Other: (specify) � ❑Multiple Family/Co�do ❑Warehouse <br /> ❑Public ❑Storage ❑ Public Water <br /> **Any earth movement quire ❑Commeraal ❑Other(specify) <br /> MCWD review 8�pertnits. ❑ 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 /> Fa�c: 952-471-0682 <br /> .minn h k. <br /> Estimated Construction Valuation(excluding land) � /lf��� <br /> �� <br /> Last Updated: 5/21/2009 <br /> -20- <br />