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. - P y, �� <br /> � " ` --��1� � 1���` S � � <br /> City of Orono b �'' � k ��'� <br /> � �� <br /> Buildin Permit A licatio � �� � �'� <br /> 9 pp � I� 0 <br /> for New Structures or Additions �a�. �S <br /> Mailing Address: Permit number: /� -�Q Gf� <br /> �,L�,� PO Box 66 <br /> Q � Q Crystal Bay, MN 55323-0066 Date received: �� O �/O <br /> �\'raT <br /> � t�`�--�:' a, Street Address:' Received by: <br /> � ��y �I <br /> �'�L� '` p�Co4�G� 2750 Kelley Parkway Plan review fee: <br /> Esx Orono, MN 55356 �U �O _ � � 9� / <br /> Total Fee: <br /> Main: 952-249�600 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 appfications will be returned. (Please print) <br /> GENERAL INFORMATION: . �` <br /> Job Site Address: ---��� �i��1K-c ���� l�'/t� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [�-Pdn <br /> If yes, a special event permit is required with Police Department and City Council approva!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 INFORMAT� N: <br /> Name: � ��� <br /> State License# Expiration Date: <br /> Phone: _ '�" � (office `� � � � ' cell <br /> Mailing Address: �� �? �. ' � :,L ' , Cit : � ZIP:�� <br /> Contact Person^ Applicant is: racto ' / Horneowner (Circle One) <br /> Email and/or Fax: � _ �u � <br /> PROPERTY OWNER INF9RMATION: <br /> Name: f�l/� ��Q.�, <br /> Phone (day): <br /> Address: ��' ,, - , � City� �'`)�,�'� ZIP�4�'���y <br /> Email and/or Fax <br /> ARCH(TECT/ 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 /> �✓"New Construction ❑ Sin le Famil with �Nater Supply <br /> g y ❑ Residence <br /> ❑ Addition attached garage ❑ Gara e/Accesso Bld <br /> ❑ Accesso Buildin 9 �Y 9• ❑ Public Sewer <br /> ry g ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ OfFice/Commercial <br /> ❑ Other: (specify) � ❑ Private Sewer <br /> ❑ 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) ❑ Othe�: (sp fy) <br /> 18202 Minnetonka Blvd �i,3/�..a ���-- <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ���-� <br /> Last Updated: 9/29/2009 j <br /> - 17 - <br />