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n�` V <br /> ti�' City of Orono <br /> Building Permit Application �j � ��� � <br /> for New Structures or Additions <br /> /�� Mailing Address: Permit number: Q/ —�D/OD <br /> y_O PO Box 66 <br /> �0 k Q Crystal Bay, MN 55323-0066 Date received: Z / l ( <br /> �� Received b <br /> �� �`�'_ f`4-��" s, StreetAddress:' Y� <br /> � ,.,.��- <br /> �'� ' p�:tl�'� �� 2750 Kelley Parkway Plan review fee: O���/—�� <br /> t �� �"�' � Orono, MN 55356 � �g� 3 q � /�! <br /> `�kEsxo�' <br /> `- Total Fee: � <br /> Main: 952-249-4600 Fax: g52-249-4616 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: ' ' ���� ��,,,D � <br /> Will this be a Parade of Homes, Remodelers Showcase ome or other Display Home? ❑ Yes ❑ No <br /> If yes, a special event permit is required with Police Department and City Council approva160 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/APPLIC T I FO ATION: <br /> Name: ���� `J C��-�-�¢�-�-. �/ 2;>> � <br /> State License# y,�—jv Expiration Date: 3- �o .��/.-2 <br /> Phone: /�Z _ -��� office ,,z r �S�- � cell <br /> Mailing Address: � � Cit : .�„ ZIP: a — <br /> Contact Person: �s>� Applicant is: �'"Contractor / Homeowner (Circle One) <br /> Email and/or Fax: �,�.;�— �,y� r�� �_ ���� � � �-�� <br /> PROPERTY OWNER INF MqTION: <br /> Name: - %,t .-r� <br /> Phone (day): �i� - - <br /> Address: ��i��; .— CityG r..r:.-.���c � ZIP: j ��3 <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER aNFORMATION: _, <br /> Name: % <br /> :G,-.Z. <br /> Phone (day): � -� - <br /> Address: o � Cit : c� � 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) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage �Public Water <br /> "'Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial <br /> ❑ 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) $ ���p - <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />