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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> � Mailing Address: I Permit number: <br /> �g�� o2D10-OG13� <br /> PO Box 66 <br /> / ���\\ Crystal Bay, MN 55323-0066 Date received: 3��Z��D <br /> ������, � <br /> �� ���'�'��,�<;_�;.� ��� StreetAddress:' �� Received by: � S <br /> c�t ��,ry�y���. �� � 2750 Kelley Parkway Plan review fee: � 5$. $(o PoC,3-� -lo <br /> ` 9riE�o�� Orono, MN 55356 a,o-ov�3g <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;. l � <br /> Job Site Address: �� �U-�1 � (�.Q �r, j� ���}� <br /> Will this be a Parade of Homes, Remodelers Show ase 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 wi/ e <br /> required unless applicant demonstrates sufficient on-site parking rs 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 I FORMATION: <br /> Name: ` ,�- S1JY' <br /> Phone (day): C � —� <br /> Address: � I C� y Cit : ZIP: �.3� <br /> Email and/or Fax " � V <br /> � <br /> ARCHITECT/ ENGINEER INFOR ATION: <br /> Name: � �� � (,� 3 m1�'l � �l .S <br /> Phone (day): <br /> Address: � cLl� �S C Cit : C�C.�'j�ls'�/!��ZIP: ��3� <br /> Email and/or Fax: O15 � � tf� _ ��� <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & <br /> ❑ New Construction �'Sin le Famil with �Nater Supply <br /> 9 y ❑ Residence <br /> ❑ Addition attached garage ❑ Gara e/Accesso Bld <br /> ❑ Accessory Building ❑ Single Family with ❑ Deckg ry g' ❑ Public Sewer <br /> _Q.Relocation � v✓,,(_ �U� 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 /> Last Updated: 9/29/2009 <br /> - 17 - <br />