Laserfiche WebLink
t <br /> � ��� I.�' � <br /> V���iv'" p ` � <br /> City of Orono <br /> ��/� ' ��� <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �j0/O—�/0,5..� <br /> �,�,�\ PO Box 66 <br /> 0 �\ � � Crystal Bay, MN 55323-0066 Date received: <br /> ����� � Received b <br /> � �°`�=x.� II <br /> � � '��,r� <br /> s, Street Address:' Y� <br /> �'�,n ��!'� �� � 2750 Kelley Parkway Plan review fee: <br /> L�kEBH 4� Orono, MN 55356 <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: — • , / / ,i� <br /> Job Site Address: �S � S� ���� �ry s, �l c� ,l/r"��eL <br /> Will this be a Parade of Homes, Remodelers Showcase Home or 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 service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLIGA�T INFORMATION: � <br /> Name: Q� m��s. .� Pr c� :N� <br /> State License# _ �?0 6 ,� �'yy9 Expiration Date: ,� ij <br /> Phone: Co?�(,. Gi, �� (office cell <br /> Mailing Address: /��! . �,,�,Q �e Cit : s� .% ZIP: J�� <br /> Contact Person: �;�,; ��,si�� �. Applicant is: n rac or / Homeowner (Circle One) <br /> Email and/or Fax: ��f irr�;,l,i,g er e v � %Q ao . �e--^ <br /> PROPERTY OWNER IN�RMATIOQI� f <br /> Name: �,..,-� .r'!�c ic <br /> Phone (day): a � G (o <br /> Address: �„�'G,f' ��>;,,, rys, � ,Q,E► City: O��X�' ZIP: �f�f�' <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: �v�/g <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 •- � l detached garage ❑ Office/Commercial <br /> Other: s cif �P/��`r k' ?� �� ❑ Private Sewer <br /> ( p/��) ❑ Multiple Family/Condo ❑Warehouse <br /> cY�t G�tS %S ❑ Public ❑ Storage ❑ PublicWater <br /> "*Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. �Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) Other: �peCify) <br /> 18202 Minnetonka Blvd �x <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ��C�O , c�4 <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />