Laserfiche WebLink
5(o <br /> p 1� City of Orono <br /> Building Permit Application7 <br /> for New Structures or Additions <br /> Mailing Address. Permit number: / <br /> O.¢O,�O PO Box 66 <br /> Crystal Bay,MN 55323-0066 Date received: J�� /a <br /> Street Address:' Received by: 0 t, <br /> a 2750 Kelley Parkway Plan review fee: 1� 0 °0./,V- <br /> Orono, <br /> 7� <br /> Orono,MN 55356 0635 191 <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: 4W5 W#1vtTOWN ktt 10 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> H yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus servke All be <br /> required unless applicant demonstrates sutilcient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: 'd AW&(Lst (14c, <br /> State License# `L3 52 Expiration Date: 1-41" ZPi <br /> Phone: -763- -6352 office cell <br /> Mailing Address: 1 4Z" Ave, Nwy Cit : rlSlNSVALt ZIP: 5 iZZ <br /> Contact Person: "P—icy, Ro-r-( Applicant is: Contractor / Homeowner (circ.one) <br /> Email and/or Fax: r ' l le @ 5aw VIo r 5r;u5 co <br /> PROPERTY OWNER INFORMATION: <br /> Name: M i " pit d. -Ai Lk- <br /> Phone(day): elS2-A3('Aeol,0 <br /> Address: ��— City: MMfU � g ZIP: <br /> Email and/or Fax Nff & t, <br /> ARCHITECT/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 Con truction El Single Family with Residence <br /> Addition �� 0m, attached garage Garage/Accessory Bldg. ❑Public Sewer <br /> Access Building ❑ Single Family with ❑Deck <br /> ❑Relocation detached garage ❑Office/Commercial WPrivate 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. ❑IndustrialPrivate 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.minn <br /> Estimated Construction Valuation(excluding land) $ r71,500 <br /> Last Updated: 9/29/2009 <br /> - 17- <br />