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City of Orono c <br /> Building pp Permit Application !a�` <br /> for New Structures or Additions <br /> _ Mailing Address: Permit number: <br /> O•g,O,�O� Cr B66 <br /> Crystal <br /> Bay, MN 55323-0066 Date received: <br /> Received by: <br /> Street Address <br /> 2750 Kelley Parkway Plan review fee: <br /> 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: 0 S TD n i�G� �1 k L, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ZNo <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: e- fy)4ArW <br /> Phone (day): &_ 1 S'j <br /> Address: It_- City: ZIP: 553SLO <br /> Email and/or Fax (� VY1CC'/lr�ii l.�% CL1YY� <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 /> ❑ New Construction ❑ Single Family with ❑ Residence <br /> ❑ Addition attached garage ❑ Garage/Accessory Bldg. ] Public Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation 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 I G 4- Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) - <br /> 18202 Minnetonka Blvd 5ta Irl? r�U � <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 />