Laserfiche WebLink
City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> PO Box 66 Permit number: ?0/ ,5—01 Vto <br /> Crystal Bay, MN 55323-0066 Date received: / /S <br /> Street Address:' Received by: <br /> y 2750 Kelley Parkway 2° �'2 Plan review fee: (L i�lcd�b <br /> �O Orono, MN 55356 <br /> Fe ,,/ <br /> '1ktsrloc� Main: 952-249-4600 Total Fee: Ey" �Y/ <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 submi d. ✓ <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 3aJ.3` tjc✓l oW �Xc'41I <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 wil e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP AN INFORM TION <br /> Name: yl n ,y/)0— <br /> State License# Expiration Date: ,3 <br /> Phone: cell office <br /> Mailing Address: 3 Oa 1 . rn+pCitx: ZIP: 33 <br /> Contact Person: , Applicant is: on rac / Homeowner (Circle One) <br /> Email and/or Fax: �r�>!�Ytn�, CQ/LS �>^ ���,cD�✓� <br /> PROPERTY OWNER INFORMATION: <br /> Name: /` "� /) r , A Aa <br /> Phone(day): �' - A - J <br /> Address: 3 4V" e vL,1' City: an 0 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: Description of project: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage 9&Deck Public Sewer <br /> ❑Accessory Building Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other: (specify) 40 e-0% Re.bbi I ❑ Multiple 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 ft � <br /> Minnetonka, MN 55345 (C� <br /> Phone: 952-471-0590 cr w <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ o <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />