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+ r <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> _ Mailing Address: Permit number: �20l;7 "b a <br /> •g,�,� PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Received by: <br /> Street Address:' <br /> \ t o~ 2750 Kelley Parkway Plan review fe <br /> Orono, MN 55356 <br /> Ess Total Fee: r / <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: <br /> Will 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: "IV H e-s. <br /> State License # + 03 7 Ex 'ration Date: 3-3)- ZDl�f <br /> Phone: �sZ� Zg —�7y� (office) 'i) t�7 S Z_gS (cell) <br /> Mailing Address: 3 ,d Ll06 City: /lf;�,,,c o.� ccs ZIP: <br /> Contact Person: �� /-E,%(w/c��� Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: -�nrS • mor., <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: )e 11.1Q City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: -s i _c <br /> Phone (day): 61? a — 76 <br /> Address: 16/Z'z y7.1 ^Ie- /i/ City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: r f " r�i•r �F-'s� � �7�;. - t. <br /> 1.Type of Project . Proposed Use T Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction (Single Family with Residence <br /> V Addition/-L i.,,cdeattached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial Private Sewer <br /> JQ Other: (specify) be--C-K ❑ 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.minnehahacreek.org <br /> v� <br /> Estimated Construction Valuation (excluding land) <br />