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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: C2D�/- <br /> PO Box 66 <br /> �/Q O Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' <br /> Received by: <br /> 2750 Kelley Parkway Plan review fee: <br /> \ Esz;o4� Orono, MN 55356 <br /> -- Total Fee: / 7 ,3� <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: <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/APPLICANT INFORMATION: <br /> Name: r! re WX Vnci . — ,r <br /> State License # a=C% 3 5 i'--1 16,- Expiration Date: 7 Zo ,, <br /> Phone: („ 1 2 -40 t(0 -4 c+r7 (office) (cell) <br /> Mailing Address: ( go F=, P4 _ 2e( City: ! '• aZIP: '5�- ; 7,( <br /> Contact Person: J0-e 4 r,e n I Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION:/ <br /> Name: CC I- 6 WP., C4 i. <br /> Phone (day): & _ & 70 It ZZ Sr <br /> Address: (o/0 t-, t(oma V, ,,, L City: (y'� :. , r l ZIP: <br /> Email and/or Fax <br /> ARCHITECT I 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 [L] Single Family with ('�Residence <br /> j�Addition attached garage ❑ Garage/Accessory Bldg. <br /> '❑AccessoryBuilding g n' 9• Public Sewer <br /> g ❑ 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 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or C <br /> Estimated Construction Valuation (excluding land) $ , <br />