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��� <br /> City of Orono ���,� ����.r... <br /> Building Permit Application - <br /> for New Structures or Additions <br /> Mailing Address: Permit number: p��l� -�Q�'�� <br /> �0,�. PO Box 66 <br /> 0 � � Crystal Bay, MN 55323-0066 Date received: �' �—' <br /> � ��,�/ <br /> a -j�. �, StreetAddress:' Received b : j�c. <br /> �'.F, �`�� Gti�' 2750 Kelley Parkway an review fee: O�a��� <br /> �kESH��`'� Orono, MN 55356 . � <br /> Tota e . <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � 3 �-f � _ z.S <br /> This application form must be completed in full and all required information must be submitted. ��r.�� �/�j�Z. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 5 �� � � <br /> Will this be a Parade of Homes, emodelers Showcase Home or ot er isp ay Home? ❑ Yes No <br /> If yes,a special event permif is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is availab/e. No/��Permitted events will not be allowed. <br /> CONTRACTOR/APP ANT INFORM TION: <br /> Name: G� <br /> State License# Expiration Date: � jJ �E" <br /> Phone: � office cell <br /> Mailing Address: Ci : ZIP: <br /> Contact Person: Applicant is: Con ractor / Homeowne (Cirele �e> <br /> Email and/or Fax: <br /> PROPERTY OWNER I FORMATION: <br /> Name: � <br /> Phone(day): ,� <br /> Address: 4�r--- ��, LL/`+ �/ �,s�,,,,b,Dk Ciry: /�p�h�j� ZIP:�� ��",� <br /> Email and/or Fax <br /> ARCHITECT/ENGINE R INF4RMATI N: <br /> Name: ��� 11J���/,f�l� <br /> Phone (day): _ -- <br /> Address: � � Cit : 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 Q���r attached garage ge ccessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ��ji H`�G ❑ Single Family with eck <br /> Relocation �j(,�7�.�1j detached garage e/Commercial ❑ Private Sewer <br /> Other. (specify) tl�iln ❑ 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 <br /> ( ) Ot er: (specify) <br /> 18202 Minnetonka Blvd ��} Qf/�v'_�i� <br /> Deephaven,MN 55391 'rJ( <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � �?� <br /> i <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />