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I � <br /> � , ��`, /�" V��\" ��1 <br /> City of Orono r � � <br /> . � 3 <br /> Building Permit Application � <br /> for New Structures or Additions <br /> Mailing Address: 020!/- <br /> ��,�,jV. PO Box 66 Permit number: OD3D Z._- <br /> �� � Crystal Bay, MN 55323-0066 Date received: 5'$` /1 <br /> �I �� '� I Received b �� <br /> 1�,a �'�t�,�;•:� �,�, Street Address:� y� <br /> ��'�,c, � . �„':'� Gti/ 2750 Ketley Parkway Plan review fee: ,�d//-003D/ <br /> �t.�Es�og,� Orono, MN 55356 0 .2../ <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: <br /> Job Site Address: �:'�� S�';s�x �,�;ti P_ G�'��v�-� �� �S3 S�' <br /> Will this be a Parade of Homes, Remodelers Showc ome or other`Display Home? ❑ Yes � No <br /> If yes,a special event permit is required with Pofice 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/APP ICANT INFORMATION: <br /> Name: � ',� r e<<�` -��a/f`S � ' .� t/��, �o� <br /> State License# p • p Q Expiration Date: � <br /> Phone: � � Z �Z ���%/ (ofFice) (cell) <br /> Mailing Address: Cit : � ZIP: � ;s'r�� <br /> Contact Person: ' � � � � Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: E'/ -- - _-U� <br /> PkOPERTY OWNER INFORMATION: <br /> Name: .)n.� '!- S ii S'a� �ra�'J�� <br /> Phone (day): �Z -, ��( -6�'y�� <br /> Address: �3 c[ S S'��s e�,�/�,7 C� City: CT.J/'c+,��� z�P: -�r3 s� <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 & <br /> Water Supply <br /> ❑ New Construction �j 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 �Othe�(specif�r) <br /> MCWD review&permits. ❑ Industnal �9�'�.-Jr,�,,r- (�'� �[1-tP� ❑ 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 />