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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions �d�w <br /> Mailing Address: Permit number: <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> II ZReceived by: <br /> Street Address:' <br /> 2750 Kelley Parkway Plan review fee: <br /> Orono, MN 55356 <br /> — _ <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 b . <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: ` <br /> Job Site Address: <br /> Will this be a Parade ofH es, 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: -� 6hq_Cc..( <br /> State License# Expiration Date: <br /> Phone: office cell <br /> Mailing Address: _ZA S S r -r,,,.. AP, City: o ZIP: - <br /> Contact Person: Applicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: C < <br /> PROPERTY OWNER INFORMATION: <br /> Name: 6 _q(-&W <br /> Phone (day): <br /> Address: 2 � ^^ a City: o'\C),� ZIP: S> S <br /> Email and/or Fax C�c�c—c�1�rc�l �c „o • <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ZeCIL, ;jam <br /> Phone(day): <br /> Address: 41 Do '�-,_ \",a\d City: i31a.,.e ZIP: 5,9%446 - <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 /> ❑ RelocationS'e detached garage ElOffice/Commercial El Private Sewer <br /> POther: (specify) ElMultiple Family/Condo ElWarehouse <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 <br /> Estimated Construction Valuation (excluding land) <br />