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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: ORO/t'-ZX)O34? <br /> 0Cr Box 66 <br /> Cry ` <br /> stal Bay, MN 55323-0066 Date received: <br /> Street Address:' Received by: <br /> 2750 Kelley Parkway Plan review fee: <br /> ��pg�e• Orono, MN 55356 <br /> Total fee: � c�4, <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: &5-0 T0,OkA .Ah- <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: -J IY Q' -9Q d.,P G0fs =A;&, <br /> State License# 1-310 Expiration Date: <br /> Phone: 12512- ?o office (rp/2-old- J' cell <br /> Mailing Address: p Oe c10 In ZIP: <br /> Contact Person: Applicant is. Contracto / Homeowner (circle One) <br /> Email and/or Fax: , <br /> PROPERTY OWNER INFORMATION: <br /> Name: I,/Ce -�- jewA . lwe z4b, /.2 <br /> Phone(day): �` 2 _- al 7-23/1 City: QZIP: $-,S�3S>!o <br /> Address: b= �IlAJb1��- �IJ� <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 4.Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction [Single Family with 5rResidence <br /> KAddition- 1 foAI AV g attached garage LJ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑Office/Commercial ❑ Private Sewer <br /> fiZ,Other: (specify) Multiple Family/Condo ❑Warehouse <br /> Ell W Aid ❑ Public ❑ Storage ❑ Public Water <br /> "Any earth movemen 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 oA <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m i n n e h a h a tree k.o r <br /> Estimated Construction Valuation (excluding land) $ <br /> Last Updated: 12/10/2010 <br /> - 19- <br />