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� c.h� q— Z�—o� <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> O Mailing Address: Permit number: —D��9�� <br /> �, ,j�.� PO Box 66 <br /> Q � O� Crystal Bay, MN 55323-0066 Date received: — ��� <br /> � ��`���� Received b � <br /> 1 a �' ���;�;,� �,iJ Street Address:� Y' <br /> �',�s, ➢'� �,� ' 2750 Kelley Parkway Plan review fee: <br /> t�'kE3H04� Orono, MN 55356 <br /> Total Fee: �c�a • lp g <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: �� � 1 r�1 � (,��� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service 11 be <br /> required unless applicant demonsfrates sufficient on-site parking rs available. Non-permitted events will not be alfowed. <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: ci �;Ol,;'G��l Ki� Ot � <br /> Phone (day): 3 --7 3 2- 2�15 L 12 . 7 5 I , � 323 <br /> Address: I115 CUx �=ar,-r, 120c� City: ��t"c?�U Z1P: 55351� <br /> Email and/or Fax KoS�-ir.�l S � i'YISn ,CD�'�'1 <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 Shc�I�(��UY�1�US(.' ❑ Single Family with ❑ Deck <br /> ] Relocation 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) i <br /> 18202 Minnetonka Blvd plav �S rGlLi� � <br /> Deephaven, MN 55391 TT�� n�JnE <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � ") ���� --- <br /> ��— <br /> Last Updated: 6/22/2009 <br /> - 19 - <br />