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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> �� Mailing Address: Permit number: D(D� QO Z70 <br /> �v�,�j�`� PO Box 66 <br /> Q F\ Q\ Crystal Bay, MN 55323-0066 Date received: ^ Z 6- /� <br /> ����r , <br /> � f�"��'�;e;`-� s.�'� S tr e e t A d d r e s s:' Received by: � <br /> ��c� � '�`�"'�� �`��% 2750 Kelle Parkwa <br /> „� + � � � Y Y Plan reviewfee: �9�•7S f�c� 3 797 <br /> r`�xEsxo4'� Orono, MN 55356 o?D/D-p D?(og <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: 3-]�I� Co�S�o <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 Counci/approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates suffrcient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT FORMATION: <br /> Name: �„��c�l' �� y�,` <br /> State License # �1��0$1`� Expiration Date: 3\ \\ <br /> Phone: �S 2-9 Zfo-lct�9� (office) � 7 V 3-Z�(o-ZYZ (cell) <br /> Mailing Address: Z3yS �j�ti,� S�� Cit : � ZIP: 3 <br /> Contact Person: � � Applicant is: Contrac / Homeowner (Circle One) <br /> Email and/or Fax: e -L �g��,,,` <br /> PROPERTY OWNER INFORMATION: <br /> Name: S���v;�S <br /> Phone (day): <br /> Address: ��g9 Scb City: Ofo� o ZIP� �'j 3�'/ <br /> Email and/or Fax �.,�� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: ��,���� � � <br /> Phone (day): <br /> Address: j� /�I.,a� 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 <br /> �Other: (specify) n! ' �e ❑ Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑Warehouse <br /> � �.��1 �K� � ` ❑ 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) $ ��.5� <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />