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� City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> - - Mailing Address: Permit number. ..��'� � �'`Z �j..`a_3 <br /> /�,0,�`\\ PO Box 66 ` � <br /> Crystal Bay, MN 55323-0066 Date received: �- � �—v <br /> �_ . ov� <br /> , � �, <br /> � � • Received by: <br /> �a � ��.� s,'; Street Address: <br /> �',�, :��_'�.�� Gti� 2750 Kelley Parkway Plan review fee: � ���� . �� � <br /> �`�kESHo�''� " Orono, MN 55356 � � <br /> _ �(�� –GU -�:��=— <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: (�'�O ��n5 �p��-t- � . <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> /f yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service wdl be <br /> required unless applicant demonstrates sutficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �-�g �PJ <br /> Phone(day): f��a- I�"- lbRO <br /> Address: �{ a hn c�t : �r� ►.r� ziP: 55 3"[ I <br /> Email and/or Fax GG�p p . Cb <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �►� Ca.l'�on�b2�Y' <br /> Phone(day): - �3- 1�f <br /> Address: y y S �J , �j�,�a� � (• City: �nq Lf}-I�� ziP: 5 5 3 5� <br /> Email and/or Fax: rw�t�l�a a� ac�on bP,r-a �,5��• c�� <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 ❑ Single Family with ❑ Deck <br /> [� Relocation l detached garage ❑ Office/Commercial ❑ Private Sewer <br /> QJ Other: (specify) C�i �,'n U�-�l ❑ Multiple Family!Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "*Any earth movement may require ❑ Commercial [�J Other(specify) <br /> MCWD review&permits. ❑ Industrial h� al ❑ 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) $ � i� � ��`.� <br /> Packet Last Updated: 10-20-2011 <br /> -20- <br />