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City of Orono <br /> t <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> Qv 0 PO Box 66 Permit number: �p / — p -j <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' Received by: <br /> o~ 2750 Kelley Parkway Plan review fee: p , p 5 <br /> �t9kE3H�4� Orono, MN 55356 a0 —t01_??_3 <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us 1 7S <br /> This application form must be completed in full and all required information must be subhflfted. <br /> GENERAL INFORMATION: Incomplete applications will be returned. (Please print) <br /> Job Site Address: O W0,ke-1p, ,e(CA <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes K 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: l.e-c.yr <br /> State License# `)p i&cS Expiration Date: a-:a ,- la <br /> Phone: aSa- 3 office cell <br /> Mailing Address: i Sdla Cit , ZIP: <br /> Contact Person: ; t S L-;X0 %"a,i7 Applicant is: ontract / Homeowner (circle one) <br /> Email and/or Fax: nvi cam. I y <br /> PROPERTY OWNER INFORMATION: <br /> Name: (R t C L I- <br /> Phone (day): <br /> Address: City' tf� � ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Citv- ZIP <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & <br /> 2 ®New Construction Single Family with S Residence <br /> Water Supply <br /> Addition attached garage ❑ Garage/Accesso <br /> ❑Accessory Building El Single Family with El Deck <br /> Accessory Bldg. ® Public Sewer <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> Other: (specify) le ❑ Multiple Family/Condo ❑Warehouse <br /> rei'•11V ❑ 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.oro <br /> Estimated Construction Valuation (excluding land) $ i 401000 <br /> Last Updated: 9/29/2009 <br /> - 17- <br />