Laserfiche WebLink
� <br /> , City of Orono <br /> � Building Permit Application <br /> for New Structures or Additions <br /> -=_--- Mailing Address: �� 14� _( �. <br /> j��.,�,��;, PO Box 66 Permit number. c.. �� <br /> �ID .� O� Crystal Bay, MN 55323-0066 Date received: -j - ( � - ,� <br /> j� �'�'��" ' � Received b : � <br /> 1�\� ✓,��:i": ��, Street Address' y � <br /> ��o, r��'c��,�,� ���� 2750 Kelley Parkway (i�� -� f' �� Plan review fee: �c-� �� �-�-C':(�l� -j <br /> \�.��� � g.�/ Orono, MN 55356 ��� ' � <br /> .�_ QHo � <br /> ----� Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 wvvw.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 print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ;-` �C?``� ���,�, ��y��.�; "� ,< <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No <br /> If yes, a specra/event permit is required with Polrce Department and City Council approval 60 days prior to the event. Shuttle bus servrce 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: J�Ct'I�-c? /4�`�Z ��2(�h`r.��S -�j�%�., <br /> State License# ��Cr C�C,�",��l�.,�2 Expiration Date: 3 - 3�-�„'2 <br /> Phone: IS a- `I 7(c l� 7(��' (office) ��,/�t- . s��, - �'y� � (cell) <br /> MailingAddress: '�� j�tl�T ��f� � Cit : ?,a� t %j ZIP: '"-� 3� <br /> Contact Person: �fe�`��� ��: ;-� r.u� (�Z Applicant is: ontractor Homeowner (Circle One) <br /> Email and/or Fax: ��,� �,�-7 hu� l�r�P v s/n c� � t�c?�2 vn. •.� <br /> PROPERTY OWNER INFORMATION: <br /> Name: J�� l� l L � � <br /> Phone(day): � - � � - <br /> Address: "�� ^' , � 'G' 'T' Cit : �f ��� �r'�? ZIP: ,� � �� <br /> Email and/or Fax ��y � , � ` � -,;,-G <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: '1 fi L �12 C�N I 7 � �.� S <br /> Phone (daY)� `t' -�- 5'G��/- / ^ �: ,� <br /> Address: ,�C 7 �?i l�n:' �rG,f�;t'1 1�`ftb'f CitY �.���Itf�'-'r�Jl� ZIP: � 5 `��i � <br /> Email and/or Fax: y.S�- Y7�'-99`�y <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> � U�- 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) ❑ Multiple Family/Condo ❑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 /> w�nv.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ lsQ, �OQ. Q C� <br />