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-_-_._-_.___._-_-� <br /> City of Orono <br /> Building Permit Application 7 7�0��� <br /> for New Structures or Additio s ...3, <br /> Mailing Address: permit number: a,-�O � <br /> �j,0,�. PO Box 66 <br /> / O Crystal Bay, MN 55323-0066 Date received: '��-� � <br /> ��X�, � <br /> II� ��'t�� �,I StreetAddress:' Received by: <br /> �\ ���,��,j. �.�'i 2750 Kelley Parkway Plan review fee: / 7.(� <br /> '�9��� ��'���g.� Orono, MN 55356 �� � <br /> k�SHo. ! a -00 �. <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: -?�C?�Z„�� C,�,�,,� ,� y t�v,,..� <br /> Will this be a Parade of Homes, Remodelers Sh6 case Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be <br /> required un/ess applicant demonstrates sufficient on-site parking is available. Non-permitted events wil/not be allowed. <br /> CONTRACTOR/APPLICANT INFOR ATION: <br /> Name: -�,� ��O�avw'S <br /> State License# (�; y.' Expiration Date: �/3i I� <br /> Phone: "'� � - '( 'ZG office �-Tk,'S- Z4-Z - �1 � l cell <br /> Mailing Address: 4 �, i Cit : i'Y '` ;.� ZIP: �r.�3 r'� "� <br /> Contact Person: �� Applicant is: on��rac�or / Homeowner (Circle One) <br /> Email and/or Fax: �� � � �� �Q - 4 Z. <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: 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 8� <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) $ � B pc�c� <br />