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- ��� � �7�-�-� <br /> � Cit of Orono <br /> y �'�'U� ���u�' <br /> Building Permit Application <br /> for New Structures or Additions <br /> — Mailing Address: Permit number: ��lO� -��_,�� <br /> ;��,�,�:�� PO Box 66 <br /> ��O ; 0��, Crystal Bay, MN 55323-0066 Date received: �'O��l <br /> � ��,� �I��I • Received b :_.___ � -- <br /> �, , Street Address: <br /> '�,�, �}��'��4��"� ti// 2750 Kelle Parkwa p���� <br /> \t �`�y��,, Y Y an review fee: <br /> kESKoz,,�G Orono, MN 55356 � _O � <br /> - — ,_' Tota e . <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us Ij� - ,3 `1 Cfi _ -z �> <br /> This application form must be completed in full and all required information must be submitted. ��r�� �7/���Z <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: � <br /> Job Site Address: � (�� � � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or ot er isp ay Home? ❑ Yes �No <br /> /f 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/APP ANT INFORM TION: <br /> Name: G(� � <br /> State License# Expiration Date: � ZI �'� <br /> Phone: � (office cell <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: Applicant is: Con ractor / Homeowner (Circle ne) <br /> Email and/or Fax: <br /> PROPERTY OWNER I FORMATION: <br /> Name: ) <br /> Phone (day): � <br /> Address: —�f�� �,�`, LGi,a �/ �;d;,d,,,�� City: /�Tl7�JQ ZIP:�,� ��',� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFO�RMATI N: <br /> Name: _/�o�_. 1�1�.SG�/,/l�,l L <br /> Phone (day): _ <br /> Address: J � � Cit : ZIP: L <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 c �, q�� attached garage ge ccessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building ��i y��� ❑ Single Family with eck <br /> Relocation ��(,�7'1�1j detached garage e/Commercial ❑ Private Sewer <br /> Other: (specify) r1 rCi1,` ❑ 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 r�r � �� 1� �-����y/�,l�i� <br /> Deephaven,MN 55391 ��Y� <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ����� <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />