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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: � �O � <br /> �Q�O PO Box 66 Permit number: _ <br /> Crystal Bay, MN 55323-0066 Date received: /— <br /> Street Address:� Received by: <br /> � ,� 2750 Kelley Parkway Plan review fee: � . / <br /> F �` Orono, MN 55356 � <br /> l�xFsxo�``` Main: 952-259-4600 Total Fee: � <br /> Fax: 952-249-4616 www.ci.orono.mn.us �(',�l ���J� <br /> This application form must be completed in full and all required informati ust e su mi , <br /> Incomplete applications will be returned. (Please 'nt) l-�`-`'� ZS <br /> GENERAL INFORMATION: °-,,T� � ,l.z=�� � ` �Z� . <br /> Job Site Address: ���n' � r��� o�' l 7'�3��07`� <br /> Will this be a Parade ^{"- � 1 her Display Home? ❑ Yes No <br /> N yes,a specia/event permi, �.� l � (_ : � ��,���`� �� ' )days prior to the event. Shutt/e bus service will be <br /> required un/ess applicant de� ���� ' � events will not be allowed. <br /> CONTRACTOR/APPL <br /> Name: � (� <br /> State License# � ;, ��j r j"1 `'C _ Expiration Date: <br /> Phone: cell j� '" Gl�,Lf-1,� � 1�ovc� <br /> Mailing Address: 7 �j � I �, � �.? Cit : �,✓�� „ u ZIP: .S-S I <br /> Contact�erson: : i � �l� � Contrac o / Homeowner �c�►cie o�e� <br /> Email and/or Fax: , '� �� � �f <br /> 1 <br /> PROPERTY OWNER INF( f� _�-'""" <br /> Name: ,�/ �� �` ,� /' <br /> Phone(day): - Ib � '`� •'� ' <br /> Address � ,� ,i r � � � � ty: p�y,�w✓� L ZIP: SJ��I'�7 <br /> Email and/or Fax �,i � ` �'�. <br /> � C�� <br /> ARCHITECT/ENGINEER 1� _ - " <br /> Name: , �'( <br /> �_. <br /> Phone(day): �i " (r��� <br /> Address: � ` � ' y � � -- �y�f�, ZIP: S S � Q l <br /> Email and/or Fax: � <br /> �f� �- <br /> PROJECT INFORMATION: _--- + ��( (� <br /> 1.Type of Project �l�Cl � U ' pe 4. Sewage Disposal& <br /> i C�� � � � Water SuPP�Y <br /> �New Construction � � � <br /> �Addition I� ' ::_-�'" ;_�:: �'ssory Bldg. �Public Sewer <br /> , L �� ;-- r � <br /> ❑Accessory Building ,_� ��� � ,�, .� � ;� � � � <br /> ❑ Relocation ,, � . ' �` ' , - __rcial ❑ Private Sewer <br /> �� warehouse <br /> ❑Other: (specify) � ���� ���'� _- � <br /> _.,,,,, ❑Storage ❑ Public Water <br /> **Any earth movement may requfre ❑ Commercial ❑ Other(speciry) <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.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � b � C�� <br /> —T <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />