Laserfiche WebLink
. . ���� <br /> � <br /> City of Orono � �� <br /> Building Permit Application <br /> � <br /> for New Structures or Additions � <br /> Mailing Address: <br /> �� PO Box 66 Permit number: tL� -L�Ul 5 <br /> j Q �, �1` Crystal Bay, MN 55323-0066 Date received: � 8 �� <br /> ii ��'i;�m_ . I /� <br /> i a t'�'j�. -`:s�;;�, • R e c e i v e d b <br /> ��� Street Address: Y� T <br /> \�c� � ;'��f�'�, ��/ 2750 Kelley Parkway <br /> `t�g ` �'�� Orono, MN 55356 Plan review fee: pZ0 l U - ('(J/ <br /> Esx� �/0 5.�/!� <br /> Iota�Fee: �- <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �� �/��p, ;� <br /> This application form must be completed in full and all required information must be submitted. <br /> fncomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �((p� Cv�i� ���� di/'Ot�O , �'�'1 l�l ��J�,� <br /> Will this be a Parade of Homes, Remodelers Showcase Home o other Display Home? ❑ Yes ❑ No <br /> If yes, a specia!event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus seivice wil!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: <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: �i��'1.1/� �a�r� ✓la <br /> Phone (day): C��'a_y,-���. p �`C-- <br /> Address: r ' j Cit : C��p ZIP: 5��3�� <br /> Email and/or Fax � � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: _ <br /> Phone (day): <br /> Address: City� ZI 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 /> ❑ New Construction ❑ Single Family with ❑ Residence <br /> ❑ Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building ❑ Single Family with eck <br /> Relocation detached garage ❑ O ice/Commercial ❑ Private Sewer <br /> ther: (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) $ t7 -(� <br /> Last Updated: 9l29/2009 <br /> - 17 - <br />