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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions r, <br /> Mailing Address: Permit number: O�OI/ �9-5159 <br /> ° 0.4?. PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: Wak <br /> Received by: <br /> Street Address:s fee: <br /> J,,il' ti`-' 2750 Kelley Parkway Plan review t' ' o Orono, MN 55356 <br /> '�kESHog' <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: 1(25161 ((-oo(2$'r <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yeses <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 I APPLICANT INFORMATION: <br /> Name: <br /> State License# Expiration Date: <br /> Phone: (Oi2— �3�-3�jS � (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: -11) "YC4 <br /> Phone (day): (Lt1Z 'Z- (4(Q ((23 <br /> Address: !'JR W t-tLIZIr°- City: Oreo kJ 0 ZIP: 5-5-3(./4 <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 ErSingle Family with I Residence <br /> • Addition attached garage 0 Garage/Accessory Bldg. 0 Public Sewer <br /> ❑Accessory Building 0 Single Family with ❑ Deck <br /> ❑ Relocation detached garage 0 Office/Commercial 0 Private Sewer <br /> ❑ Other:(specify) 0 Multiple Family/Condo 0 Warehouse <br /> 0 Public 0 Storage 0 Public Water <br /> **Any earth movement may require 0 Commercial 0 Other(specify) <br /> MCWD review&permits. 0 Industrial si Private Well <br /> Minnehaha Creek Watershed District(MCWD) 0 Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq O <br /> Estimated Construction Valuation (excluding land) $ 2D DOD , • <br /> Last Updated: 4/26/2011 <br /> - 19 - <br />