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i <br /> City of Orono <br /> Building Permit Application 1 <br /> for New Structures or Additions <br /> 0- MailiPgO Bdox 66 Permit number: - <br /> �\ 0 Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' - 1 Received by: <br /> o` 2750 Kelley Park ay / ( �L4d Plan review fee: 3W 9 <br /> Orono, MN 5535 <br /> ikEsso4` <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 /> .pub Site Address: <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? F.Yes ❑ No <br /> /f 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: L..:, <br /> Phone (day) (� 1 Z rZ/-; 2. <br /> Address: i<:2 7Y i_ �%� t,�.e /J City: J'1��it ZIP: <br /> Email and/or Fax X ;2\ N 4'� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: _ I U{�I {���� i\�r! City: 2'rL ��r` City: �� n�t •�; ZIP: r`� `) 2 <br /> Email and/or Fax: <br /> > ✓ `"7 <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. >;�Vublic 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 ❑.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 /> Estimated Construction Valuation (excluding land) $ <br />