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., <br /> : D(./ <br /> City of Orono �.�o�ib <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: D/D-�D .5� <br /> �,�,�. PO Box 66 ,/ �a /O <br /> O `\ Q Crystal Bay, MN 55323-0066 Date received: '7 <br /> ' �'� Received by: <br /> ,� �' ` �, Street Address' <br /> ����� ti 2750 Kelle Parkwa <br /> �c� � '��' v Y Y Plan review fee: <br /> r9kEsxo4`'� 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: (� LO �� � <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 e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP A T INFO ATION: /,�r <br /> Name: � �S l/`�� <br /> State License# Expiration ate: <br /> Phone: office c II <br /> Mailing Address: p Cit � ZIP: <br /> Contact Person: Applicant is: ontracto / Homeowner (Circle One) <br /> Email and/or Fax: �, <br /> PROPERTY OWNER INF RMATIO . �,l ` <br /> Name: t�,� <br /> Phone(day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <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 ���/yy� ❑ Single Family with ❑ Deck <br /> Relocation �r .,� �� detached garage ❑ Office/Commercial ❑ Private Sewer <br /> Other: (specify) GN11�N ❑ 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 /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ (� " <br /> Last Updated: 9/29/2009 <br /> - 17- <br />