Laserfiche WebLink
CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �0�0 Mailing Address: Permit number: 13 - 0 0511 <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' Received by: Q <br /> y ` 2750 Kelley Parkway Plan review fee: l> <br /> �g <br /> Orono, MN 55356 kFsHo�``o oZD l�- OO Sl CD <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 J 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: c ,t/,AJpy;— <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: City: ZIP. <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER MORMATION' <br /> Name: I/\/tt.-i-I 4'nen <br /> Phone (day): 7-,3-- J 63 77 3�3_ <br /> Address: `!y t;D prz-ti/E City: ZIP: sS � <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: Description of project: _ Z �/ -vc/ C7 _; Ce bdzL e-,F <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 1',4^ F-] Public Sewer <br /> ❑ Accessory Building ❑ Single Family with 0 Deck x-1 1*4) , <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> F1 Other: (specify) ❑ Multiple Family/Condo [:1 Warehouse C-D.Wo <br /> El Public O►�l Vie PJ <br /> Public Storage I . <br /> **Any earth movement may also require ❑ Commercial ❑ Other(specify) tX <br /> MCWD review&permits. ❑ Industrial <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 h <br /> Phone: <br /> Fax: 952-471--471-0682682 7ClT►��L <br /> www.minnehahacreek.org <br /> Estimated Construction Valuation (excluding land) <br />