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� <br /> . <br /> � <br /> City of Orono ��. � � �'� <br /> Building Permit Application <br /> for New Structures or Additions <br /> MailingAddress: Permit number: d� `� �a y <br /> �A, PO Box 66 <br /> � 'V� Crystal Bay, MN 55323-006 Date received: <br /> Street Address:� �� l Received by: <br /> F ,� 2750 Kelley Parkway Plan review fee: <br /> c,` Orono, MN 55356 ����/ _ <br /> t�'rfSHv�� Main: 952-259-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us �l� <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: � SCO dl�� 0 � <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 with Police Department and City Council approva160 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPL C NT INF RMA ION: <br /> Name: � e 1 P <br /> State License# 2 Expiration Date: 20 <br /> Phone: cell - office <br /> Mailing Address: 37 ! J Cit : I�i q ZIP: <br /> Contact Person: Applicant is: Contractd / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFOR ATION: <br /> Name: .E�� �1 <br /> Phone (day): ZO - 0 � <br /> Address: �' Cit : Q� /� ZIP: �3q� <br /> Email and/or Fax r c .CO <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�ect: <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 �arage/Accessory Bldg. � Public Sewer <br /> ❑Accessory Building ❑ Single Family with Deck <br /> Relocation } detached garage ❑ Office/Commercial ❑ Private Sewer <br /> Other: (specify) PC A[f h�l ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage j7�J 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) $ �Q� O�o <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />