Laserfiche WebLink
City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: d d�3�D � <br /> O�,�,�.0 PO Box 66 � <br /> Crystal Bay, MN 55323-0066 Date received: �- l���� <br /> ,� ,A�, �, StreetAddress:' Received by: <br /> �',�, �ti�' 2750 Kelley Parkway Plan review fee: <br /> L9kESH��`'� Orono, MN 55356 � <br /> Total Fee: � �� ,��j <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 submitte� � <br /> Incomplete applications will be returned. (Please print) � � <br /> GENERAL INFORMATION: ._.� nn <br /> Job Site Address: '� � �� � c���-f �c�c �'— 'J�' - � � ���=� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes <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/APPLICAf�.T INFORMATION: <br /> Name: ��1� �c,�✓�-e .-- <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: City: ZIP: <br /> Contact Person: �.:e S�Q� �,�� .- �1 Z-Sz'J o-�j 3,� Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: WGa�y SS �J �a{�0•C9ryv` <br /> PROPERTY OWNER INFORMATION: <br /> Name: t� � �`�. �(F 1 �.- i:�u ��E'l.���-��� <br /> Phone (day): ��, y;��,`1� v��:��'t 3 C211� <br /> � <br /> Address: ' 4s � +�- c� ` 11�c�� Cit : �J��. 7a c:�_ ZIP: �� ��� <br /> Emailand/orFax cr��,u7�c�r���b";�;w�yfu�n�c� •�:z%�--� <br /> r; � <br /> ARCHITECT! ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZfP: <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 /> ❑ 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 ❑ Storage �Public Water <br /> "*Any earth movement may require ❑ Commercial her pecify) <br /> MCWD review&permits. ❑ Industrial ��1►ce �L,., 'n�- ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) �"f�ther: (specify) <br /> 18202 Minnetonka Blvd ���.y��N}{e .��i�:r�\ <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> ,�� <br /> Estimated Construction Valuation (excluding land) � /�� <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />