Laserfiche WebLink
....„ An bK_ -11+E TACT- <br /> ellu,.5L FSP <br /> City of Orono i-VW1—\ <br /> Building Permit Application .�� <br /> for New Structures or Additions a3 <br /> Mailing Address: Permit number: 61240//"00/7 <br /> (6302- <br /> 0„ ,�T Cr 3 Box 66 <br /> k4 , Crystal Bay, MN 55323-0066 Date received: /A'7z Jfl <br /> `"'” `.. Received by: <br /> A i .re'-':., ', Street Address:' . �I <br /> vs, i F^'tilMo~ 2750 Kelley Parkway Plan review fee: <br /> � 1 ' �,g�' Orono, MN 55356 <br /> kEsso /t ea)/ 3 <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: "-{7o0 W€sk'grr vt4. F-✓ OrciPo MJ? 55304 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes N 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/APPLICA�T�,IrN�FOJ2M�C(JN�� <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.:. ��ii <br /> Name: " no i)cc1cA, '�Cvi(YD1n <br /> Phone(day): - _ 55 <br /> Address: 7 `�jrCLy1� � <br /> 1 d Citcov '� <br /> ✓ � �Q ZIP: (p`? <br /> Email and/or Fax 'y �Xj 5Z, 97Z, /79I ''cam( <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 Constructionater Supply <br /> Cl❑ Single Family with El <br /> ❑Addition attached garage ❑ Garage/Accessory <br /> ❑ AccessoryBuildingg Bldg. ❑ Public Sewer <br /> ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> ❑ Private Sewer Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public Storage El 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.orq <br /> Estimated Construction Valuation (excluding land) $ I n ,C.' <br /> Last Updated: 1/26/2011 <br /> - 19- <br />