Laserfiche WebLink
1 <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> PO Box 66 Permit number: <br /> !V Crystal Bay,MN 55323-0066 Date received: A?--5 <br /> Street Address:' Received by: 2 — <br /> y 2750 Kelley Parkway Plan review fee: 3 + 9 <br /> e� c` Orono,MN 55356 d/ 5 <br /> gkfsHoMain: 952-249-4600F <br /> To<i <br /> 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: 11 g() pis\ 0 `' <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? El Yes 3 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 /> C"TRACTOR/AP ANT INF ION: <br /> Na 6" w O \►J <br /> Sta a xpira <br /> P I _ <br /> Maili s Ci \ <br /> Conta erso n I a n <br /> Email a d 2^ <br /> PROPERTY OWNER INFORMATION: <br /> Name: v X DN <br /> Phone(day): G r5 j • <br /> Address: t Ia.S N 1 LkA City: } 00I,jp ZIP: <br /> Email and/or Fax C J•-A <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ( YTi tN t��5\6NJ <br /> Phone(day): . —x,:)-LA- 3610A <br /> Address: 2-Lok-"s `c - City: 6;)U477-4-0 ZIP: 5h i <br /> Email and/or Fax: L tg-nN Csof,�, <br /> PROJECT INFORMATION: Descri tion of ro'ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> 9 New Construction Single Family with ElAccessory Bldg./Garage <br /> ❑Addition attached garage ❑Deck ❑Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑Relocation detached garage Residence Private Sewer <br /> ❑Other:(specify) ❑Multiple Family/Condo ❑Retaining Wall(s) <br /> ❑Public 4-feet or greater ❑Public Water <br /> "Any earth movement may require ❑Commercial ❑Storage <br /> MCWD review&permits. ❑Industrial ❑Warehouse Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other:(specify) ❑Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) 313 7,C00 <br /> RECEIVED <br /> Packet Last Updated: August 2015 <br /> Page 21 DEC U 5 ZU1/ <br /> CITY OF ORONO <br />