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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> -�-; Mailing Address: Permit number: <br /> g,0, PO Box 66 _ <br /> 0 , O Crystal Bay, MN 55323-0066 Date received: <br /> a { ,, Street Address:' -- <br /> „j Gti 2750 Kelley Park6�7 <br /> 1Cp�40 Plan review fee:0Orono, MN 5535 <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mmus <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: <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: <br /> Phone (day) 1 p 11- c� �%i; — I -rc�_1: <br /> Address: e-yP_r_1U;% i �'r� `y, 7' i7 (1.e_ /J City: ,/l�ir�li ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: I'ZiN <br /> Phone (day): jp f 2, fJ <br /> Address: I C t '3 '� �► ! k` if\. z tJu City: '� �� ,,-� .�) ZIP: <br /> Email and/or Fax: <br /> �✓ — <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> %New Construction i Single Family with Residence <br /> /]Addition attached garage ❑ Garage/Accessory Bldg. ublic 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 /> u� <br /> MCWD review&permits. ❑ Industrial rivate 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.or <br /> $ <br /> Estimated Construction Valuation (excluding land) <br /> f <br />