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City of Orono <br /> Building Permit Application Jrq �S' <br /> for New Structures or Additions <br /> Mailing Address: O�l0_z <br /> �+0.11 PO Box 66 Permit number: <br /> 01 0 Crystal Bay, MN 55323-0066 Date received: <br /> - Street Address:' Received by: <br /> �Gti 2750 Kelley Parkway Plan review fee: <br /> If <br /> ESH04 Orono, MN 55356 <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us Total Fee: <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: l <br /> Job Site Address: Q e �` al <br /> Will this be a Parade of Homes, Rem-ode ers 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/APPLIQANT INFORMATION- <br /> Name: A- <br /> L�SoR! c�1� <br /> State License # p 13 jig ,( Expiration Date: �� <br /> Phone: 4W q — office — 41-5 cell <br /> Mailing Address: fd' City: 2ct/ <br /> Contact Person: Applicant is: ontra / Homeowner (circle one) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: &114- G.aV <br /> Phone (day): — y � <br /> Address: 7 ya e,-,a L fe.( d City: Q901,lo ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <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 /> ElNew Construction ❑ Single Family with ❑ Residence Water Supply <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building ❑ Single Family with Deck 41--eaeK Pot�� <br /> ❑ Relocation 7 detached garage ❑ Office/Commercial <br /> ❑ Other: (specify)Qe.K�� ' o� C}�tS ❑ Multiple Family El Private Sewer <br /> P Y/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 Sc Ce <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.org <br /> Estimated Construction Valuation (excluding land) $ <br /> Last Updated: 9/29/2009 <br /> - 17- <br />