Laserfiche WebLink
City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> 0 PO Box 66 Permit number: 2D(5—ooG <br /> l v0 Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' IZ I� <br /> 2750 Kelley Parkwa "Z�OO <br /> Orono, MN 55356Plan review <br /> �1XFSHO Main: 952-259-4600 Total Fee: <br /> 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:' SCT, � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes <br /> tf 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 INFORM TION: <br /> Name: <br /> State License# Expiration Date: <br /> Phone: cell ? -��- office <br /> Mailing Address: ?7 Y u%,� Cite ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: I r ry;Ze ( ej,, rNn <br /> PROPERTY OWNE INFO TION <br /> Name: (,r(/ I't <br /> Phone (day): Z ._ S_S; <br /> Address: \ City: p ZIP: Ss <br /> Email and/or Fax rl f*vvl!I Vxn I.C-ciM <br /> ARCHITECT/ENG EER IIZtFOR TION: <br /> Name: >t�� <br /> Phone(day): <br /> Address: W it j, ZIP: s I-' <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 /> ❑ New ConstructionWater Supply <br /> ❑ Single Family with El Accessory Bldg./Garage <br /> ❑ Addition attached garage ❑ Deck <br /> [:1 Accessory Building El Single Family with ElOffice/Commercial El Public Sewer <br /> ❑ Relocation �n detached garage ❑ Residence <br /> r�r El Private Sewer <br /> ther: (specify) <br /> El 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: (specify) ❑ 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) $ <br /> 4W <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />