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City of Orono 7 <br /> Building Permit Application g,,a� <br /> for New Structures or Additions <br /> —=- Mailing Address: Permit number: <br /> O•g,�,�0 Cr Box 66 <br /> Cry _ <br /> stal Bay, MN 55323-0066 Date received: <br /> T. Received by: <br /> t P_-111Orono, <br /> StreetAddrE.2750 Kelley Parkway Plan review fee: <br /> gMN 55356 <br /> _ d�/_ <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 o <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/APPL CANT INFORMATI N; , <br /> Name: io 'L�i v Oh <br /> State License# Expiration Date: <br /> Phone: oL. c 7 5- 2,019office L S- o cell <br /> Mailing Address: 3 +" _ /o/ Cit i y ZIP: 3 5l <br /> Contact Person: 4Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: h ,' <br /> PROPERTY OWNER INFORMATION' <br /> Name: kv <br /> Phone(day): 3'2G� <br /> Address: City: ZIP:9,� <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: <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 /> Relocation detached garage ❑ Office/Commercial ❑ Private 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. ❑ 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 />