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f � • � <br /> .� � ; City of Orono <br /> ilding Permit Application <br /> or ew Structures or Additions <br /> --__ Mailing Address: Permit number: <br /> PO Box 66 . Z <br /> Crystal Bay, MN 55323-0066 Date received: �J <br /> � k <br /> 1 �C\ <br /> �`�,� �'���-: Street Address:� Received by: <br /> \'�, ����� 2750 Kelley Parkway Plan review fee: vZ—�dl 79 <br /> \�.y'°�• ,<�� Orono, MN 55356 �7 (� pp <br /> jfEsB�g' � / �O / • p / <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-24911616 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 /> JobSiteAddress: t � �� 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 approva160 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: �- - � <br /> �, c � <br /> State License# �� " � �"'r Expiration Date: <br /> Phone: ' `� -- office cell <br /> Mailing Address: � �� � � - Cit : L ZIP: " -- <br /> Contact Person: � ��� Applicant is: cCon`�ractor_, / Homeowner (Circle One) <br /> Email and/or Fax: �-,-�,�'; � �ck� L,,�,-,�°,� �'> .�-C�[.. � ��1��--� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ,( - � <br /> Phone (day): ` ._ � � <br /> Address: �' �/ - Cit : ZIP: 1 c - <br /> Email and/or Fax '� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ,�;;r'�"i�c L--���F��^ <br /> Phone (day): <br /> Address: = v c -c� � Cit : � � ZIP: �� <br /> Email and/or Fax: �' � r��� <br /> PROJECT INFORMATION: <br /> 7.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 Bldg. � Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑Office/Commercial ❑ Private Sewer <br /> ❑Other: (specify) �j Multiple Family/Condo ❑Warehouse <br /> [� Public ❑Storage � Public Water <br /> **Any earth movement may require ❑Commercial ❑Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other: (speCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952�71-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � �^�- _ (,� �j f�� <br /> :� ����dF,� ^�j:�c�, c��:�- <br /> '�� ���Id�� r`�/:����}�c.� � <br /> i <br />