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City of Orono 5 <br /> 5�- °� <br /> Building Permit Application <br /> � <br /> for New Structures or Additions <br /> Mailing Address: �Q`, �f�� <br /> �,0,�. PO Box 66 Permit number: <br /> ��, � � Crystal Bay, MN 55323-0066 Date received: U /f <br /> �� ��'' - I Received by: <br /> �1,a �t� � �,�, Street Address:' J� ��' �/ <br /> ��'� � �� �ti� 2750 Kelley Parkway Plan review fee: v <br /> �t ���� ��`r � Orono, MN 55356 <br /> �ESHO,�`'/ ;;�L���`��� � <br /> �' -- � Total Fee: ` <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This appfication form must be completed in fuli and all required information must be submitted. <br /> Incomplete applications will be returned. (P/ease prinf) <br /> GENERAL INFORMATION: <br /> Job Site Address: � �� �� ��! ��•,.; <br /> Will this be a Parade of Homes, Re odelers� howcase Home or other Display Home? ❑ Yes No <br /> !f yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service wrll be <br /> required unless applicant demonstrates suffrcient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/ PLICANT INFORMATION: <br /> Name: �j�e-�U(.�_ ,�a,�S � ��.�S����'�� 'r;. � <br /> State License# (���c 6,�7 6 c�,� Expiration Date: �- 3� , (� <br /> Phone: '7(0`3 -}//� - S�z 3�, (office) 7C�.- y,2,p- y,�Y'7 (cell) <br /> Mailing Address �-��� � �� �-rt, /�-✓�, ,v City: ,.� ZIP: SS 3 `� f�� <br /> -,,e � <br /> Contact Person: �,�� (��, Appficant is: �-Cbntr � / Homeowner (Circle One) <br /> Email and/or Fax: �4;�'�� � " �'�(�,� C; ,� <br /> PROPERTY OWN INFORMATION: <br /> Name: � �:�•n �� /� <br /> Phone (day): �J �.—y,��/ - � 7��� <br /> Address: �_� _ City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <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 8� <br /> Water Supply <br /> ❑ New Construction �ingle 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) ❑ Muitiple 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) $ o'2$,pU�� <br />