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. � ��� ,�- :� <br /> ���,� �� City of Orono <br /> � � <br /> Building Permit Application <br /> for New Structures or Additions ���'� �� <br /> Mailing Address: ;��'/!- ,l��r � <br /> j�,O,j�� PO Box 66 Permit number: <br /> � O .� O <br /> Crystal Bay, MN 55323-0066 Date received: -/ - 1� <br /> �� <br /> ���a "'�''� "`" a,�, Street Address:� <<G Received by: l��-) �''k f� �«K:�rE� �����7C-' <br /> `"�'� � �� ti� 2750 Kelley Parkway `�L�CC #�`, t-�— P an review fee: � <br /> \����r��G Orono, MN 55356 � � � J � �� � <br /> �?fEsxo1''/ <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 applic�tions will e returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes, a specia/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 ailable. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICA I FO M ION � <br /> Name: (1 , (� <br /> State License# Expiration Date: <br /> Phone: • � office) cell <br /> Mailing Address: � Cit : ' ZIP: <br /> Contact Person: ' Applicant is: ontrac o / omeowner (Circle One) <br /> Email and/or Fax: (� <br /> PROPERTY OWNER INF TION: <br /> Name: <br /> Phone (day): � <br /> Address: ' Cit : ZIP: <br /> Email and/or Fax <br /> ARCHITECT I ENGIN ER FORMATION: <br /> , <br /> Name: <br /> Phone (day): _ � <br /> Address: Cit : 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 mgle Family with �2esidence <br /> � Addition r ��� ��m�Y� r �attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> Accessory�uilding 1 ❑ Single Family with ❑ Deck <br /> ❑ Relocation �,(N r� detached garage ❑ Office/Commercial <br /> ❑ Other. (specify) - �(� ❑ Muiti le Famil /Condo ❑ Private Sewer <br /> p y ❑Warehouse <br /> � C{-U � ❑ Public ❑ Storage ❑ Public Water <br /> ""Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review 8�permits. ❑ Industrial <br /> ❑ 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) $ <br />