Laserfiche WebLink
� - '' <br /> / <br /> �� <br /> . City of Orono �j� � <br /> Building Permit Application � <br /> � <br /> for New Structures or Additions <br /> --- Mailing Address: ���� _ <br /> ,; <br /> � �\� PO Box 66 Permit number: `` � <br /> �' ,�'':. <br /> �/� , Q� Crystal Bay, MN 55323-0066 Date received: � '�/S ���=� <br /> �I �"' . I� Received by: �F� <br /> 41,,� �� ' ,,;, StreetAddress:' <br /> \�`� �_:,� titi�/ 2750 Kelley Parkway �� '�J . �"f � �? �' <br /> ��cA �„ �x� � Cc� � � Plan review fe � (;�/.� — �� � <br /> \�k���o�,�� 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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: _.� �'C``j Lf���C� ��:���; �L,� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No <br /> lf 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/APPLICANT INFORMATION: <br /> Name: ���I�,. N f` Z l�«�t h`z ��_5 .(��-L_ <br /> State License# "::,L C�C:�:S`!,��- Expiration Date: ,� � 3/-��2 <br /> Phone: %5� - y '7(� (� 7(�,5�' (office) �!.� - "5'�c�> =�''Y 4' �� (cell) <br /> Mailing Address: '�,.�' ry'�� ��311 Cit : C .;� ' - t �1� ZI P: i � �` <br /> Contact Person: � •��� � 5�� i-� r,�,iy9 (L � Applicant is: ontractor a� Homeowner (ClrcleOne) <br /> Email and/or Fax: 5� �1 t.�:=c �r' T h,_;� /��lc� -�:�i✓� �� �: '_�a{1 vc.'��v� � <br /> PROPERTY OWNER INFORMATION: <br /> Name: �c; � j_�, l L r `� <br /> Phone (day): � � - ' ' � . <br /> Address: �ri��7 �=(f��� �C�t Y�.�7 � City: �� ,�'C,�2.�L) ZIP: � � �`j� <br /> Email and/or Fax � r:r �� ' -�i� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ��-' ' �� ! �= ' S <br /> Phone (day): ' ,;Z- �� - -• - � <br /> Address: SC 7 �)�.i/�lL' i �C,(C,T� �it:f CitY� Lt�I�tf C i'i T/'� ZI P: � 5 ;�� � <br /> Email and/or Fax: yS�- Y�(�-Qg�(`� <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> �^�� Water Supply <br /> ❑ New Construction � (_,7�" •,� ❑ Single Family with Residence <br /> ,�.Addition �� � attached garage Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Oifice/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage ,�Public Water <br /> "*Any earth movement may require ❑ Commercia� ❑Other(specify) <br /> MCWD review�permits. ❑ Industrial ❑ Private Well <br /> Mi�nehaha 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 /> �,v�r�w.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �SQ, �pQ, 0(� <br />