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, �. <br /> ► - <br /> . <br /> •� City of Orono <br /> Building Permit Application <br /> for New Structures or Additions ��� <br /> �_�� Mailing Address: Permit number: ��` ° � <br /> ��.,�,�� PO Box 66 � <br /> i� �';, Crystal Bay, MN 55323-0066 Date received: <br /> � � _ �� <br /> �11� ���'�'�c���`. �.� Street Address:' Received by: � � ��". <br /> ���'� ��;�!�� �ti� 2750 Kelley Parkway Plan review fee: �� � ' (� � <br /> `�'� � <br /> \kESH�g' 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: G�,�S ���,, yo„�..� �� <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�ie <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events wil!not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �,.-�s�-c�„����I� P�:l�c�s r: <br /> State License# ���;�a�7�Z� Expiration Date: 3-3i-�l[U <br /> Phone: (v 1�-�11`-I-7S�� �{e#ic�J___ Ce� <br /> Mailing Address: a S a , Cit � (> ZIP: /'� �� <br /> Contact Person: � �c �-��,,� Applicant is� Contr to� / Homeowner (Circle One) <br /> Email and/or Fax: �,ty �; �� ; e� d -- <br /> PROPERTY OWNER FORMATION: <br /> Name: � ,1,,�,. . _ n <br /> Phone (day): k,� - , - "7� <br /> Address: �B�S C�scc� n�.;�. �d CitY� �����1('U ZIP� /V��'� ,5_S�`I l <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> ❑ New Construction Water Supply <br /> ❑ Single Family with �Residence <br /> �Addition attached garage ❑ Gara e/Accesso Bld <br /> ❑Accessory Building ❑ Single Family with ❑ Deckg ry g' ❑ Public Sewer <br /> ❑ Relocation detached garage ❑ Office/Commerciaf <br /> ❑ Other: (specify) ❑ Private Sewer <br /> ❑ 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) $ �5��!p��'> <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />