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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> O 4� MailiPO Box 66 ng Address: Permit number: 0�0 f!(^ 7 5 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address: <br /> Received by: <br /> 2750 Kelley Parkway Plan review fee: <br /> Orono, MN 55356 <br /> \_ mosso <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:L� �� � © � <br /> Job Site Address: l <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 <br /> lft <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: W,-\k — , <br /> State License# Expiration Date: -Lo <br /> Phone: office 3 ( cell <br /> Mailing Address: 3S rC-A_Q Cit 'OLA_n.( ZIP: <br /> Contact Person: D&OS& Lotti Applicant is: <9c o Homeowner (circle one) <br /> Email and/or Fax: nS,�62 c 2 v Lk- <br /> PROPERTY OWNER INFORMATION: <br /> Name: -T-1) -ii,_ <br /> n�beAy, <br /> Phone(day): _ q5 D 1>'o Q 9 <br /> Address: _K4.6 tDrAtn ,, O r City: Vrnno ZIP: <br /> Email and/or Fax ro b l LiD MS c_ a_�po . C a yy�- <br /> ARCHITECT/ENGINE R INFORMATIONS�� � <br /> Name: ��y`ZI�_RL-1�LX S 7Ta'L:- <br /> Phone(day): i <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 /> fW New Construction ❑Single Family with ❑ Residence <br /> Addition attached garage ❑Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑Office/Commercial ❑ Private Sewer <br /> ❑Other: (specify) ❑Multiple Family/Condo ❑Warehouse <br /> ❑Public Q Storage ❑ Public Water <br /> —Any earth movement may require ❑Commercial Other( eciN) <br /> MCWD review&permits. 0 Industrial U13 OY'ILS It-G te ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) Other: (spe ify),p <br /> 18202 Minnetonka Blvd 0y -Si <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation(excluding land) $ 12A , 0 00 . <br />