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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: <br /> 'Q0 <br /> v Cr Box 66 <br /> ` Crystal Bay, MN 55323-0066 Date received: <br /> Received b <br /> a % Street Address Y <br /> 1S. t ,A,4ji:i ��' 2750 Kelley Parkway <br /> t9i$' •1,6 Orono, MN 55356 Plan review fee: <br /> kEHt� <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 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 will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: 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: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & <br /> ❑ New Construction Water Supply <br /> ❑ Single Family with El <br /> ❑Addition attached garage ❑ Garage/Accessory <br /> ❑ AccessoryBuilding9 Bldg. ❑ Public Sewer <br /> ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> ❑ Private Sewer <br /> ❑ Other: (specify) <br /> E 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.org <br /> Estimated Construction Valuation (excluding land) $ <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />