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�,r�`' ��� <br /> . � a��`� <br /> City of Orono I � , .--� <br /> Buiidin Permit A lication ��' �� <br /> J pp � <br /> for New Structures or Additions <br /> Mailing Address: Permit number: p�Q/� —�/'�( �f� <br /> �0,�. PO Box 66 ' / <br /> Crystal Bay, MN 55323-0066 Date received: �/y�/o� <br /> 0�.:�y�:. � <br /> �a ''�!';{ -�` ,, , StreetAddress:' Received by: <br /> �'�c, ��, ���' 2750 Kelley Parkway Plan review fee: <br /> \r � , Orono, MN 55356 <br /> '�$�sxo4`'/ <br /> ,_,_--___=- �D 3. 3� <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: � S U �l(J�✓1/ �� S <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuftle bus seivice will be <br /> repuired unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP CAN INFOR ATI N• <br /> Name: � � <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNE NFORMATIO : <br /> Name: �L� � � �� <br /> Phone (day): L- � (� <br /> Address: � �,y Cit : j'� ZIP: �� ,3 S <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. P oposed 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) $ � l V�� �� <br /> i � <br />