Laserfiche WebLink
� . _ _ _ _ _ _ _ <br /> �. � � <br /> , � . � �� � � <br /> ► � ,��ti . <br /> City of Orono •7� <br /> Building Permit Application <br /> � � �� <br /> for New Structures or Additions <br /> �� Mailing Address: �, <br /> � �\� <br /> PO Box 66 Permit number: 0/D -p(Ja,� <br /> Q F,\ o\� Crystal Bay, MN 55323-0066 Date received: �-/C/ -/l7 <br /> `�p�';`�4,�r, �I <br /> �� s.l StreetAddress:' � <br /> .� ��'��;��-�::` Received by: <br /> ,�' 'z '�"' ti/ <br /> cnt�'����,'�.,, ��� 2750 Kelley Parkway Plan review fee: 9�8�1 <br /> �kESH�4/ Orono, MN 55356 a4/O- D <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: � '�<<����;�- ��r � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a specra/event permit is requrred with Po/ice Department and City Counci/approva/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�c�F�,S�.rl/.� �5 �.c•� �1��< • C:"''/I1�GZ <br /> State License # �-�0�17,�0o Expiration Date: <br /> Phone: r1h3 - `/ =//,Y� (office) � -3� -jaa3 (cell) <br /> Mailing Address: � o � ..(u� < <' Cit : ,tZy,�la„i/� ZIP: �s.r=� <br /> Contact Person: __"L-U,c,, ���q�ocoF',¢ Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: _ /��,q/�b,�,�z �' /y�,ci ,c�,oc� ��� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �p.� � /17i1,et7 /���r�ic� <br /> Phone (day): ��yJ-lyy_ ��ef37 <br /> Address: ,��5 �'�,�,/��.,� `"�,� City�O�� ZIP -`�js.�s � <br /> Email and/or Fax <br /> __a_,, <br /> ARCHfTECT \ENGI R INFORMATION: <br /> Na `i�o�1Gc S�-+'cr�ci�G <br /> Phone (day): �j�_ � y � � �- <br /> Address: ,�. � �6� ��,o,�,�,G �K Cit � ZIP� <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 ❑ Deck <br /> �Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> Other. (specify) �C ❑ 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 /> 182C2 Minnetonka Blvd <br /> Deephaven, MN 55391 i <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 />