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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: Q��— <br /> g,0,� PO Box 66 <br /> O O' Crystal Bay, MN 55323-0066 Date received: <br /> a Street Address' Received by: <br /> 2750 Kelley Parkway <br /> ly �G Orono, MN 55356 Plan review fee:, <br /> rtEsgo4 ¢yam(( <br /> Q <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us Total Fee: <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: p n <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �ZLNo <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: ► p 1 (, <br /> State License# 20 31' /411 0 Expiration Date: 3 /a <br /> Phone: i7_(ml(o-y ycr1 (office) (cell) <br /> Mailing Address: y,s it City.. ZIP: S <br /> Contact Person: _loge fire-n II a r Applicant is: n rac / Homeowner (circle one) <br /> Email and/or Fax: ;J Vel 6 fe#1n4H 141 C&S. ,eV o-1 <br /> PROPERTY OWNER INFORMATION: <br /> Name: _ X ( ffe7gd p <br /> 1 1 � <br /> Phone (day): 01-7-1,2-70 <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Citv: Zi P' <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & <br /> ❑ New ConstructionWater Supply <br /> ❑ Single Family with El Residence <br /> [�Addition attached garage ❑ Garage/Accessory Bld <br /> ❑ AccessoryBuilding 9 Y 9 El Public Sewer <br /> g �; Single Family with Deck I <br /> ❑ Relocation detached garage �❑ Office/Commercial ❑ Private Sewer j <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 <br /> ❑ 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 /> Last Updated: 9/29/2009 <br /> - 17- <br />