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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> PO Box 66 Permit number: — �� <br /> 0 <br /> Crystal Bay, MN 55323-0066 Date received: !s /.S <br /> Street Address:' Received by: <br /> y 2750 Kelley Pa <br /> Orono,MN 5535 p��=()U $'�� Plan review fee: S • Z <br /> 0SHo�� Main: 952-249-4600 d C Z <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> Thisapplication form mustU caff,rlplet6d"* fup grid all required'(nf ion Must, subtalft <br /> GENERAL INFORMATION: Incomplete�apptications virlll Ilia retpmed.. (Please print) <br /> Job Site Address: 2Za i?r*oZz g P419 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes YNo <br /> ff yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service wil 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: �G <br /> State License# Ex iration Date: <br /> Phone: cell -7. office Z— <br /> Mailing Address: Cit / ZIP: <br /> Contact Person: &I 4,re�- Applicant is: ontracto / Homeowner (circle one) <br /> Email and/or Fax: �� z�r,��q. J��_ � q - —c:t <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: 2.7.0 61c.�e fir tj /PB,¢,0 City do-eoma-✓p ZIP SS'3�? [ <br /> Email and/or Fax ��"f-8 T 1�1� ,�e4 Ce�i <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Z New ConstructionWater Supply <br /> ❑ Single Family with Accessory Bldg./Garage <br /> ❑Addition attached garage LJ Deck ❑ Public Sewer <br /> ®Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence <br /> ❑ Private Sewer <br /> ❑Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> "Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) Other: (speci C9 Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ S 0 <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />