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C��y -: �� � <br /> � ��� <br /> City of Orono a l 1 . �o <br /> Building Permit Application <br /> for New Structures or Additions ao� - 0003 <br /> ,—=_=_-; Mailing Address: Permit number: <br /> O�,0,j�.\\ PO Box 66 <br /> \ Crystal Bay, MN 55323-0066 Date received: ! / <br /> a � ? �,1�I� Street Address:' Received by: <br /> '�' � �` ti`�' 2750 Kelley Parkway Plan review fee: �� . 3 ` 5/� <br /> �1.�' � gw� Orono, MN 55356 _D <br /> itEsxo,. �!'l/ l <br /> �-_—_�' Total Fee: <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 submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: �, � � � <br /> Job Site Address: �,�U /� <br /> Will this be a Parade of Homes, Rem 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 sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLIC�4NT INFORMAT ON: <br /> Name: � ., - <br /> State License# �QC �!�/,s�� Expiration Date: , <br /> Phone: ���- � . office cell <br /> Mailing Address: ,S'jy � C' � ZIP: <br /> Contact Person: � Applicant is: / Homeowner (Circle One) <br /> Email and/or Fax: � � - ' <br /> PROPERTY OWNER INFORMATION: ��" � al���r �� �� <br /> Name: ��,� ' ��o �� <br /> Phone (day): - - � <br /> Address: o o � Cit : ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ti'�,/�Q' <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& <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 ❑ 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) $ / �do,, — <br /> i <br /> Packet Last Updated: 10-20-2011 <br /> -20- <br />