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, . City of Orono <br /> � uilding Permit Application <br /> fo New Structures or Additions <br /> � -- Mailing Address: Permit number: ��� — <br /> PO Box 66 <br /> � Crystal Bay, MN 55323-0066 Date received: 3 <br /> � <br /> j �s;:+� <br /> ���. Received by: <br /> `a Z ,, StreetAddress:' <br /> \� ;����' �� 2750 Kelley Parkway Plan review fee: U/� —Ud�7 <br /> �gESKo�`� Orono, MN 55356 p <br /> '—__— <br /> Total Fee: �� � D <br /> Main: 952-249-4600 Fax: 952-249�616 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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: '�S �Cj�J( 1 � r,,.'-r <br /> Will this be a Parade of Homes, rco...�delers 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 be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: � - � - � <br /> State License# ; Expiration Date: <br /> Phone: � -� -_ � office cell <br /> Mailing Address: v . � Cit : ZIP: � � - <br /> Contact Person: � �� Applicant is:/� onfr`a�/ Homeowner (CircleOne) <br /> Email and/or Fax: _�;n,,,` z.. ���1,,,,�,t; c�3 ,,�.�L LCj� <br /> PROPERTY OWNER INFORMATION: <br /> Name: - L <br /> Phone (day): � ._ C • <br /> Address: �/ � Cit : ZIP: <br /> Email and/or Fax '� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ;�-�!'�JC.� L--���rsc�_V'` <br /> Phone (day): <br /> Address: r � /�,� 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 8 <br /> Water Supply <br /> Q� New Construction ❑Single Family with �Residence <br /> C7 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 ❑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: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � L i� — � (� ` �,� <br /> � ������-�� _���Ll, C�vu <br /> '��s �o�l���- ��/������z� - <br />