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/ <br /> � . <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �� '�� <br /> .�O A TO PO Box 66 <br /> �V Crystal Bay, MN 55323-0066 <br /> Date received: �� �" <br /> StreetAddress:' Received by: <br /> y � 2750 Kelley Parkway Plan r ' <br /> F ��,� Orono, MN 55356 - / <br /> 11KESH04 Main: 952-259-4600 Total Fee: / �, ��,L <br /> Fax: 952-249-4616 www.ci.orono.mn. � <br /> This application form must be completed in full and all required in�formatron bmitted. <br /> - Incomplete applications will be returned. (Please print) � � <br /> GENERAL INFORMATION;; < <-/� / � <br /> Job Site Address: Z } C.._/�-•' �-�%J•-- � �-- <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> If yes, a specia!event permit is required with Police Department and Ciry Council approva160 days prior to the event. Shuttle bus service ill be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICA T I ORMA / <br /> Name: _r,e�Gc-��- � G�t u r��r�. < <br /> State License# Expiration Date: <br /> Phone: cell � ' office <br /> Mailing Address: p S . .i Cit : � ZIP: .��� <br /> Contact Person: � AppliCant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: �. � /J �r � <br /> PROPERTY OWNER O MATI� / <br /> Name: l� � - `G4 <� l'`.� <br /> Phone (day): / Z - 7 a �S-�o �' S — <br /> Address: � 7 ZS�� C� ���'�� � ��-- -� Cit : c�.%.��v ZI P:S~S:S�� <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: Description of project: <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 f��� 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 /> �Z:s�t� �_ <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />