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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: Z 753 <br /> 0 . O�O Cr CryBox 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Received b <br /> Street Address:' Y' <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: -I vo r <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 A be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR i APPLICANT INFORMATIO <br /> Name: Jill r-2 '21MCa,1J LAU <br /> State License# Expiration Date: <br /> Phone. (office) (cell) <br /> Mailing Address: City_---- ZIP: <br /> Contact Person: Applicant is: ontractor / Homeowner (circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): 12.- l20 L <br /> Address: L4Wyy-,(lam City: ZIP: <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 ❑ Residence <br /> ❑ Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ElOffice/Commercial ❑ Private Sewer <br /> [IG Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> ""Any earth movement may require ❑ Commercial 1W Other ecify) <br /> MCWD review& permits. ❑ Industrial ' I El 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 rninnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ U���- <br />