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__ <br /> City of Orono �'����° <br /> �~� <br /> Builc�ing Permit Application � <br /> �. # <br /> for New Structures or Additions <br /> Mailing Address: � Permit number. — � � <br /> .�CL� PO Box 66 ' �� � <br /> y_ � Crystal Bay, MN 55323-0066 Date received: '�j� ` <br /> 0 , � <br /> � ��� /�,� <br /> �,��;�»,. <br /> ,� i���, �, y, • Received b <br /> � �� , e,;,;�. StreetAddress: y� <br /> � ��� �'•"�� ��� 2750 Kelley Parkway <br /> t '�1� � ,� i Plan review fee: <br /> `�kEsxo4 Orono, MN 55356 � <br /> � Total Fee: /�} <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � V�,, ��`. d <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please rint) <br /> GENERAL INFORMATION: � <br /> JVu vi��`^, iA-lvUii�J�. <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home7 [� No � <br /> If yes, a specia!event permit rs required with Police Department and City Council approval 60 days prior to the event. Snuttle bus servi � <br /> required unless applicant demonstrates sufi`rcient on-site parking rs avai/able. Non-permitted events wil/not be al/owed. <br /> CONTRACTOR/APPLICA I FORMATION: � , <br /> Name: <br /> � <br /> State License# Expiration Date:t <br /> Phone: (office) � (cell) <br /> Mailing Address: City: • ZIP: <br /> Contact Person: Applicant is: Contractor / I�omeowner (Circle One) <br /> Email and/or Fax: • <br /> PROPERTY OWNER INFORMATION: 4 <br /> Name: <br /> Phone (day� i <br /> Address: Cit : ZIP: <br /> Email and/or Fax <br /> ARCHiTECT/ ENGINE F R N: � � � � �s <br /> Name: <br /> Phone (day); <br /> Address: Citv: ZIP� <br /> Email and/or Fax <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� I <br /> ❑ New Construction ❑ Sin le Famil with Supply � <br /> ❑ Addition g Y ❑ Residence <br /> attached garage ❑ Garage/Accessory Bldg �] Public Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> [3 Other: (specify) ' ❑ Multiple Family/Condo se � Private Sewer <br /> ❑ Pubfic ! Sto ❑ Public Water <br /> i ""Any earth mov ❑ Commercial er specify) <br /> MCWD review& permits. ❑ Industrial Privafe Wel <br /> Minnehaha Creek Watershed District(MCWD) I [�Other: (speCif ) <br /> I18202 Minnetonka Blvd <br /> Deephaven�Mh4 9 , � <br /> Phone: 952-471`� � �� ��.� � i <br /> Fax: 952�7.1-06 � i <br /> www.minnehahacreek.or ! <br /> Estimated Construction Valuation (excluding land) � <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />