Laserfiche WebLink
. • • �(�� <br /> � <br /> . ( � <br /> ��� � <br /> � ; v Cit of Orono � � <br /> � �'" � �. y C�, � <br /> �, „�� ; .�`I <br /> �. � � ���'� Building Permit Application <br /> for New Structures or Additions <br /> . ---- Mailing Address: Permit number: pl �� e� " (�7� �jp <br /> �:g,�,�:\ PO Box 66 <br /> / � �,�, Crystal Bay, MN 55323-0066 Date received: �� <br /> �i �' <br /> �f � II • Received by: <br /> ��i,� � � �,,; StreetAddress: <br /> �'�' ��� ����� '� ti%� 2750 Kelley Parkway Plan review fee: <br /> �;�.y'����"���;����� Orono, MN 55356 <br /> �<<kEsxo4'',- <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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �`-��7 1�-` �t(�, <br /> Will this be a Parade of Homes, Remodelers 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/APPLICANT INFORMATION: <br /> Name: �l��-t'�'���-�== ���[..c..�"7Z'S �riCL��d-e-� <br /> State License# �1�:3� Expiration Date: <br /> Phone: (,���0 office (cell) <br /> Mailing Address: � '" Cit : ZIP: t"-,��-'> �- <br /> Contact Person: j � l�N Applicant is: on racto / Homeowner (Circle One) <br /> Email and/or Fax: t 4�y cJ <br /> PROPERTY OWNER INFORMATION:/," ' <br /> Name: f�`�'rC�c,t'l� <br /> Phone (day): Gj'�-J �,-7 - Z� �- <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGIN�ER INFORMATION: <br /> Name: ���,��C� 5��� <br /> Phone (day): ��/- ��J(U - , „ /�� <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) -t'1�,� � ❑ 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) $ t��l/��d`�� <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />