Laserfiche WebLink
lD <br /> City of Orono (I'vV <br /> Building Permit Application S a lb <br /> for New Structures or Additions <br /> — ` Mailing Address: / <br /> 0�\ PO Box 66 Permit number: o?O/o2 -DD 9'� <br /> r O\ Crystal Bay, MN 55323-0066 Date received: 94l// 2— <br /> i <br /> I ��\ +r 1 <br /> ,{ �, Street Address:' Received by: <br /> \�cnt'l +� oti``' 2750 Kelley Parkway Plan-reviewfee: - 7 I �ik- <br /> '�Esz;o4� Orono, MN 55356 o�D/a.= 'S <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: "T 703 Coe r Of)(k �c) UCOnc- <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes SPA 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.e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP I T INFORMATION: <br /> Name: '4 <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 OWNERINFORMAT�I <br /> Name: Hr ? 1–t,--fertS0 <br /> Phone(day): _ : _ r , C' a <br /> Address: •• �l "� t k „ A Lt rano Cit : ZIP: <br /> Email and/or Fax ��taldosc(3,.,� bJ <br /> s e '' -,cc-, . C,0r <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 SupplyXNew Construction Sin le Familywith ❑ Residence <br /> El Addition attached garage ❑ Garage/Accessory Bldg [' Public Sewer <br /> ❑Accessory Building ❑ Single Family with Deck .m.}0_,,_c.�.Q.c <br /> ❑ Relocation detached garage ❑ Office/Commercial Private Sewer <br /> ❑ Other:(specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public El Storage ❑ Public Water <br /> '*Any earth movement may require El Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial XPrivate 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) 41,8nocclo <br />