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�1,�A I f 0��A, ,�, <br /> City of Orono <br /> • Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: — Q// <br /> PO Box 66 <br /> 9 O Crystal Bay, MN 55323-0066 Date received: /�— <br /> Street Address: Received by: <br /> o` 2750 Kelley Parkway Plan review fee: <br /> \tR ;ogw Orono, MN 55356 <br /> SH <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: Z) U 4, v, �A� R 4 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes Z] 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: C <br /> State License# Expiration Date: <br /> Phone: t),,z 36 -3?,F S— (office) guc�� (cell) l z36^ <br /> Mailing Address: Cit ZIP:S s3-Ps <br /> Contact Person: '. Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: i,t�L,✓ S_jr Zvo <br /> PROPERTY OWNER INFORMATION <br /> Name: �M I(�S l zr <br /> Phone (day): L2 5_/ <br /> Address: City:L,'f f fP_ C',-04 ZIP: <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: Ctie <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 ❑ 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 tti <br /> Phone: 952-471-0590 i�irC l ' <br /> Fax: 952-471-0682r- <br /> www.minnehahacreek.org C 1 <br /> Estimated Construction Valuation (excluding land) <br />