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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address. Permit number: Q �U <br /> PO Box 66 <br /> � Crystal Bay, MN 55323-0066 Date received: <br /> Street Address. Received by: <br /> 2750 Kelley Parkway Plan review fee: <br /> �yxESHo4*� Orono, MN 55356 <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: { t <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 I APPLICANT INFORMATION: <br /> Name: .J Lf F/,1--2,-S C,L_ C <br /> State License # 0,5—P Expiration Date: 3- <br /> Phone: - a16 - le0%) (office) -7C3 - Y?f- 0 2�1- (cell) <br /> Mailing Address: S7 1 ,J6ft Sal City: pl-. ZIP: S" -.1.59 <br /> Contact Person: Applicant is: ractor / Homeowner (circle one) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: T -,f mak—. City: C' = 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 /> 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 ElOffice/Commercial ❑ Private Sewer <br /> Other: (specify)----' � ��. J ❑ 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 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.rninnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ yC7o, <br /> Last Updated: 6/22/2009 <br /> - 19 - <br />