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�( � <br /> . " �," <br /> City of Orono � � � <br /> Building Permit Application <br /> for New Structures or Additions o��_��o v <br /> Mailing Address: Permit number: � <br /> O�O,�.O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �0 '�—�Z <br /> a -a'A�, �, StreetAddress:' Received by: <br /> �'.�c, " G��' 2750 Kelley Parkway Plan review fee: ��5• � f� <br /> r�ESH04'� Orono, MN 55356 ��a_�� <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: _ ('��jGO �� <br /> Job Site Address: �j�f �,�-���— ��, ,�_ <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 Council approval 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/API'LICANT INFORMATION: <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 OWNER INFORMATION: <br /> Name: (e�A�� /��l�� S%�v� c. <br /> Phone (day): �_ . , � � - <br /> Address: ���� F��y� r�� i�`jf�C City: fc��,s/ �j-�4,c'CZIP: 5��/�_ <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: �r'����' i � C��s c� r�T � p!� <br /> Name: �/n �1 � <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 & <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) �oi¢r uS� ❑ 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 T ! <br /> Deephaven, MN 55391 �Q� / ` ��S� <br /> Phone: 952-471-0590 ���.'� �j�c�� <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � Uvv � <br /> � <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />