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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: <br /> �v�,�. PO Box 66 <br /> Q � Q Crystal Bay, MN 55323-0066 Date received: <br /> ;��y�, <br /> I-� f�,?a;4 Ls'�. s, Street Address: <br /> � Received by: <br /> \�'.�, � ' �r�,q„ �ti 2750 Kelley Parkway Plan review fee: <br /> '�9k��o4� Orono, MN 55356 <br /> ESH <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: '� �� � �, ' � � j^o,�ro � 5 -3 �� <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 Counci!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: r � ��� �'�� �v� �!'���� i ;,� �ryt C <br /> State License # xpiration Date: <br /> Phone: �' , T�-(�j�j '' office cell) <br /> Mailing Address: 6 j� � "�- ��_�_Y Cit : �« w ZIP: -�_�' % <br /> Contact Person: — �,� � Applicant is: Contracto / Homeowner (Circ�e One) <br /> Email and/or Fax: �,�/' , �' ���� �/��: ,� .. Co <br /> PROPERTY OWNER INF MAT ON: <br /> Name: �,.. v s�t G - <br /> Phone (day): `� - 10 -- <br /> Address: �� �� �, �c�� Cit : �i�o/lcu ZIP: S 5 3 �� <br /> Email and/or Fax �j � �, � � � , �v <br /> ARCHITECT/ ENGINEER INFORMATION: � / <br /> Name: i�,(�� �t C <br /> Phone (day): <br /> Address: City: Z�P: <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 /> ❑ w 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 L/vT�y /Zoo!= ❑ 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 />