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City of Orono LD <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> 0 PO Box 66 Permit number: <br /> Crystal Bay, MN 55323-0066 Date received: -'Oq <br /> Street Address:' Received by: <br /> Gti5 2750 Kelley Parkway Plan review fee: <br /> Ho4� Orono, MN 55356 <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: �i c� !��- o!o'lc� - ' ` -1, 1> t I _ <br /> WII this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes 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 service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: _ City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION- <br /> Name: ;v),tcit- c„VA1, <br /> Phone(day): c1�7? - z e - 5_5f5l <br /> Address: City: ZIP: <br /> Email and/or Fax r.,c►�.a Ja►�`� �4H <.�t-wx� <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 /> L1New Construction [7f Single Family with [Residence <br /> ❑Addition attached garage ❑Garage/Accessory Bldg. [Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Deck <br /> ❑ elocation detached garage E]Office/Commercial El Private Sewer <br /> LJOther. (specify) CAe '��"I` ❑Multiple Family/Condo ❑Warehouse J <br /> F1 Public El [�J 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.minnehahacreek.org <br /> Estimated Construction Valuation (excluding land) $ <br /> Last Updated: 6/22/2009 <br /> - 19- <br />