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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> = Mailing Address: Permit number: p�l�j'�� g <br /> ,'�,�,j�.� PO Box 66 <br /> /�Q Q,, Crystal Bay, MN 55323-0066 Date received: o?,J/•�-- , <br /> '�� S x��i. - �� R?��ix��by /Yf <br /> `,a y � . a.;, Street Address:' � <br /> \�� ,��� ' �%� 2750 Kelley Parkway Plan review fee: . <br /> r�''��•�;'��`���y�G%"� Orono, MN 55356 <br /> `�k�sHog.,. <br /> `--`� Total Fee:� _ . — <br /> Main: 952-249-4600 Fax: 952-249-4616 �� . �%� _ pu l <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � G �zz�j'�'�"> <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 wdh Police Department and City Council approval 60 days prior to the event. Shuttle bus service ll be <br /> required unless applicant demonstrates su(ficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: _����,� � ` �rtilc�.� <br /> State License# Expiration Date: <br /> Phone: — -, -- office cell <br /> Mailing Address: ,,,�D ' h � Cit : , ZIP: ' <br /> Contact Person: a c Applicant is: Contract r / Homeowner 1 (Circle One) <br /> Email and/or Fax: ,� <br /> PROPERTY OWNER INFORMATION: <br /> Name: //.sc��. � i%vl�t�S' <br /> Phone(day): % �— - / � <br /> Address: ,� j(`���- Cit : � � L�'/�ZIP: <br /> Email and/or Fax / �r <br /> ARCHITECT/ ENGINE INF RMAT N: / <br /> Name: /r" �/�/L/`' �f'c ��� <br /> Phone (day): � <br /> Address: '-GS N t' Cit : � C" ' /' P: �� � <br /> Email and/or Fax: — ,f . �� <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal 8� <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: s eci ' G1/ � � ❑ Private Sewer <br /> ( p fy) ❑ Multiple Family/Condo ❑Wlrehouse <br /> �. ❑ Public ❑ Storage ❑ Public Water <br /> "'Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial <br /> ❑ 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 /> coww-minnehallacreekurc <br /> Estimated Construction Valuation (excluding land) $ /� /�e:=�'� � <br />