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. . (� '� � lv <br /> City of Orono �' L. � <br /> Building Permit Application ; � ��� <br /> �� � <br /> for New Structures or Additions <br /> MailingAddress: Permit number: q�b/c� ^d��GJ 2- <br /> g,0,�. PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �O S ?� <br /> O"�s.::���:, � <br /> �a ''�'�{ -'` ,, , Street Address:' Received by: <br /> �'�, ,�`� �ti�' 2750 Kelley Parkway Plan review fe: <br /> �t �' , `� � Orono, MN 55356 �I <br /> �E�xo4 ¢� <br /> - - Total Fee: �T? ���, [�(� <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 appli�ations will b turne . ( s � rint) <br /> GENERAL INFORMATION: � /1 <br /> Job Site Address: CU <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other isplay 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 availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR I AP LICANT INFO MA N: � <br /> Name: �� �- � <br /> State License# �' Expiration Dat : - <br /> Phone: � office cell <br /> Mailing Address: > Cit � ! / ZIP: <br /> Contact Person: Applicant is: on ractor Homeo er (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER NF RMA N: <br /> Name: � <br /> Phone (day): - <br /> Address: Cit : � ZIP: <br /> Email and/or Fa� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <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 ❑ �arage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building � ❑ Single Family with �]�Deck <br /> ❑ Relocation ,J detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ 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 <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 />