Laserfiche WebLink
� City of Orono <br /> Building Permit Application ���D , 7 5 c(� <br /> for New Structures or Additions <br /> , — Mailing Address: Permit number: oZU�� d d�� � <br /> � � PO Box 66 <br /> ' �" ,� ',> <br /> �Q Q�', Crystal Bay, MN 55323-0066 Date received: � � ' <br /> x n <br /> ��,� ��,'jt, �II Street Address:' Received by: <br /> ���'t���;�'� ti��' 2750 Kelle Parkwa o� 8 9v�,� <br /> ��c� �? �xt �;% Y Y Plan review fee: � <br /> ��qg�sHog�j/ Orono, MN 55356 0?0//_�.j�</ <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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 2j'OqS �(�p ��. �p(�t.d <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 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: ���- ��lw� [�►�d �pH/�,rS ,lY�,(_ . <br /> State License# ��(�'�-- Expiration Date: ?��►� �t_ <br /> Phone: ti- �q office 1-3lD - 1 I cell <br /> Mailing Address: $ �,.{(,�. Cit : ZIP: S3 <br /> Contact Person: ��y� q,y Applicant is: Con rac or / Homeowner (CircleOne) <br /> Email and/or Fax: �`��. �p��yv�,,� @ �`�h�y�,-F d�{�Q,yS.Go►'� RS2- y'1lo-u�� <br /> � PROPERTY OWNER INFORMATION: <br /> Name: � ; � � <br /> Phone(day): - La <br /> Address: Z.. Cit : t� ZIP: } <br /> Email and/or Fax ;� <br /> ARCHITECT/ ENGINEER INFO MATION: <br /> Name: q,v�, <br /> Phone(day): Z- o - v , <br /> Address: �( h, Cit : ZIP: <br /> Email and/or Fax: 0. <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 ❑ 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&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 />