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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: <br /> 0, PO Box 66 <br /> 0 O Crystal Bay, MN 55323-0066 Date received: (` - —Q_ <br /> A ;, y, Street Address:' Received by7 <br /> *4 Gti� 2750 Kelley Parkw CG -3'1� Plan review fee: �{ <br /> �•gkHog� Orono, MN 55356 I r1 iz- <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: r ga?v <br /> Irl Site Address: (p <br /> Will this be a Parade of Homes, Remodelers Showcase He e it other Display Home? ❑ Yesill No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus servai wbe <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> \ <br /> CONTRACTOR/APPLICANT INFORMATION: / <br /> Name: 5 �W, "n r <br /> State License# Expiration Date: /— <br /> Phone: office cell <br /> Mailing Address: D Cit ZIP. <br /> Contact Person: G Applicant is* on ractor / Homeowner (Circle One) <br /> Email and/or Fax: ✓r Pi- Mn. <br /> PROPERTY OWNER INFORMATION: J <br /> Name: <br /> Phone (day): <br /> Address: City: 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 wage Disposal& <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with F71Residence <br /> ❑Addition attached garage Garage/Accesso Bldg. ❑ Public Sewer <br /> Accessory Building ❑ Single Family with eck <br /> ❑ eiocation 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&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.min nehahacreek.or <br /> v J <br /> Estimated Construction Valuation (excluding land) $ 3!y <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />