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. , <br /> . � � �� <br /> City of Orono �,. <br /> � 1� <br /> Building Permit Application � <br /> for New Structures or Additions <br /> Mailing Address: '7 n!/�—OQ � <br /> PO Box 66 Permit number: O�(J 1�� <br /> �O�Q Crystal Bay, MN 55323-0066 11n Date received: " —�� <br /> r- <br /> StreetAddress:' a� Received by: �— <br /> y� ,� 2750 Kelley Parkway �� Plan review fee: h' . �l <br /> c,` Orono, MN 55356 ��!�l��� � <br /> `qkfSHO�� Main: 952-249-4600 Total Fee: <br /> 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: � �, , �'% f) .; r � ,��� / � <br /> Will this be a Parade of Homes, Remodelers S owcase Home or other Display Home? ❑ Yes ❑ No <br /> /f yes,a special event permit is required with Po/ice Department and City Council approval 60 days prior to the event. Shutt/e 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: �� ' � � � - � '��>� � � �� "i� i '�'��r� � ; �� -- <br /> State License# ' ��;L� � ��� Expiration Date: <br /> Phone: (cell) �,,.� ���a �`-,`� �.v (office) >� � --, . _; , _,--�` ,y <br /> ` ' <br /> Mailing Address: �'� ZIP: � ,` - - <br /> ' '�X > Cit : � -- < �. �: , _, <br /> Contact Person: y"y�l, �C--� j.�•,� 2 Applicant is: ontractor � Homeowner �c�►oie o�e� <br /> Email and/or Fax: ;�`�r ' ';� � -�;�_� :��f'��� a. Y ,i-t _ �- <br /> � ��:� a � c c� � <br /> PROPERTY OWNER INFORMATION: <br /> Name: I�;�i''>"�' t � L�_�-- ( �L��'�1 � �-�i_���- ��: <br /> Phone (daY): ��,��S I• ��1�i S- U�-}-1�,�_ <br /> Address: y1,��� �,t�'k'S=r ��'1 City: rl')i�'1r>(�-(�"��ljj� ZIP: �;. <br /> Emailand/orFax �� � � '��_�� - ��� 1��� . � � <;� ��' �; �4b1�{� t z� ,v� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: ZIP: <br /> Email and/or Fax: � <br /> PROJECT INFORMATION: Descripti <br /> 1.Type of Project . �� 4.Sewage Disposal& <br /> 5 Water Supply <br /> �New Construction [� � ' � <br /> ❑Addition ��� ❑ Public Sewer <br /> ❑Accessory Building [, <br /> ❑ Relocation a � � �Private Sewer <br /> ❑ Other: (specify) ❑ . � -lj � r � <br /> ❑ F � l �� ��(,LL ❑ Public Water <br /> ''`Any earth movement may require ❑C ) � ,//� <br /> MCWD review&permits. ❑ In � � �G �"' �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Ot A � � <br /> 15320 Minnetonka Blvd tt <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land, � �)�`� � ��'.� r� �.J�J <br /> Packet Last Updated.• August 2015 <br /> Page 21 <br />