Laserfiche WebLink
City of Orono - <br /> Building Permit Application <br /> for New Structures or Additions <br /> �—_ Mailing Address: Permit number: (�/D-���.5 <br /> �v�,�� PO Box 66 <br /> 0 , Q� Crystal Bay, MN 55323-0066 Date received: cJ- / <br /> ���� <br /> � ��"�'��e;;,. s, StreetAddress:' Received by: <br /> �c� ���,��� ��F/ 2750 Kelley Parkway Plan reviewfee: <br /> t9jrEs_—�� Orono, MN 55356 <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. (P/ease prinf) <br /> GENERAL INFORMATION: i1 � , Ad ! v <br /> Job Site Address: �a�� CAS� CtIRC-�.� � "V��Zi�T� rv`„' �$� r� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or ot er 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 rs available. Non-permitted events wil/not be allowed. <br /> "�,:�.._�� <br /> CONTRACTOR/ PPLIC ORMATION: <br /> Name: �/'i �j t L�C�- <br /> State License# Expiration Date: <br /> Phone: � �{-► � � � �Z (office) (;i a 7�f3 y�os'-�{cell) <br /> Mailing Address: ,kSCc� C dZCC,F Cit : W_ Z���}.. ZIP: � <br /> Contact Person: 5 i 1,,5 �T"V� Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER I RMATION: <br /> Na me: ��i/�� �� i �.5 F��--- <br /> Phone (day): �" �' <br /> Address: C/ �' C �,�C. Cit : �21� ZIP: ,S `.���/ <br /> Email and/or Fax � � � � <br /> ARCHITECT/ENGINEER.�N�ORMATION: <br /> Name: _ lll, ,�, <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 <br /> ❑ Other: (specify) ❑ Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "*Any earth movement may require ❑ Commercial ❑ Other(specify) , <br /> MCWD review 8� 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) $ 3 �p <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />