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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> /�0, PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Permit number: o�D//'�71:3 <br /> Crystal O <br /> I) Received by: <br /> 1,a Al Street Address:' <br /> ti`s / 2750 Kelley Parkway Y Y Plan review fee- <br /> Orono,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: <br /> Job Site Address: , <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes WNo <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 Aube <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: J cU 7,egL1\C: C_ <br /> State License# _- <br /> Phone: Z _ "o (office) cell <br /> Mailing Address: 'ZST/& r� Cit <br /> Contact Person: _S�7e 6sj,, q!'S aZ Applicant is: o ractor / Homeowner (circle 04.) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: E�> l, :l�',—` �w� QcX City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: e'� <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 P,Single Family with Residence <br /> Addition attached garage Garage/Accessory Bldg. ❑ Public Sewer <br /> Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> F-1 Other: (specify) El Private Sewer <br /> ( p fy) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public Storage ❑ Public Water <br /> —Any earth movement may require ❑ Commercial Other(specify) <br /> MCWD review &permits. ❑ Industrial <br /> ❑ 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 />