Laserfiche WebLink
� City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: or��S--(� 9D <br /> � �� PO Box 66 <br /> Q Crystal Bay, MN 55323-0066 Date received: 7—��— S <br /> StreetAddress:' Received by: {�/� <br /> � ,� 2750 Kelley Parkway � <br /> y�' c,` Orono, MN 55356 Plan review fee: <br /> lqKfSHO�� Main: 952-249-4600 — o � -S—�� D � <br /> Fax: 952-249-4616 ww�.ti�.ci.orono.mn.us �� �U� C'� <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) ��j-�S�� j ;—i 3 't5 <br /> GENERAL INFORMATION: ✓ -J <br /> Job Site Address: � � �d ��� � <br /> Will this be a Parade of Homes, Remodelers Sh wcase 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 will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Nam e: l" o�� S�_t-� 6ZG � �� c'� ��"��'Lv c r � �w �-- � �,` <br /> State License# 1`� � o � � 3 �a Expiration Date: � ���\- 1 C <br /> Phone: cell ('i'�'�_ �— ''�� � � (office) � r Z� `�� '�- � 5 ��,�� <br /> Mailing Address: � -� S o e3 � S� Cit : V� C b (�) L� ZIP: S �' � � <br /> Contact Person: �' �� ��y Applicant is: Contractor, / Homeowner �c���ie o�e� <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: G �. G �C v� � 6 �� c� 1� <br /> Phone (day): C � �- "� "J� — � <br /> Address: � � � � c o� � A �.`� d�0 �� City: � �c� �d ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: "� ° d t,� � <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8 <br /> Water Supply <br /> � New Construction � Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> *"Any earth movement may require ❑ Commercial Storage <br /> MCWD review& permits. ❑ Industrial Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑ Other(speCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.mmnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � �� b � � ! � C <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />