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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> MailingAddress: Permitnumber: � -00 �7 <br /> � \ PO Box 66 <br /> � � ��� 09 <br /> j � �\ a Q\\I Crystal Bay, MN 55323-0066 Date received: <br /> � �� �I Received b <br /> ' =�=.p a, � StreetAddress:' Y� <br /> �� 2750 Kelley Parkway Plan review fee: <br /> �L�kESH��'� Orono, MN 55356 <br /> Total Fee: ��2 <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: �Z- Z �j�-��-'n-�-'��1� �2-- <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 Deparfinent and City Council 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: �ti�� S M �'I-fi-� ��r�,�� . -�/� <br /> State License# 5 30-� Expiration Date: 3-- 3 i -�� <br /> Phone: a - -� _ 6 S c office � i � - �s E��7- 3 / 1 cell) <br /> Mailing Address: 6S - �- S 2 Cit : �w/V e �C" ZIP: " ` �, <br /> Contact Person: '��`, Applicant is:�� ractor Homeowner �c���ie �e� <br /> Email and/or Fax: �V}�i2,�r.�r�.;g��� � C,�y„� <br /> � <br /> PROPERTY OWNER INFORMATION: <br /> Name: j�.�� CVl v I 1�a. 1'� <br /> Phone (day): �� � - a.o i --`a�b O <br /> Address: 2z. z B e �r w�,o r�'_� Cit : O�►ti [� 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 /> New Construction Water Supply <br /> ❑ Single Family with ❑ Residence <br /> ❑ Addition attached garage � Gara e/Accesso Bld <br /> ❑ Accessory Building g rY 9� ❑ Public Sewer <br /> � 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) $ "� ,2�'Q — <br /> -20 - <br />