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, - <br /> � <br /> � � h � City of Orono � �, �� � <br /> � � � 9 <br /> Building Permit Application � <br /> for New Structures or Additions <br /> �-���� Mailing Address: Q � I <br /> g,�,��� PO Box 66 Permit number: <br /> O �:, O� <br /> Crystal Bay, MN 55323-0066 Date received: 2.- q <br /> ��} �, <br /> '�� r�'�;��s-*'- �,� Street Address:' Received by: <br /> ���� '°t�p�:��,,� G��;, 2750 Kelley Parkway Plan review fee: �q'•�j �z�i�� <br /> 9,kEs�j Orono, MN 55356 ^�� � °`� <br /> I <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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ,;1jt�(;� J�,���'� ; <br /> Will this be a Parade of Homes, Remode rs Showcase ome or other Display Home? ❑ Yes ❑ No <br /> !f yes, a specia!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/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 OWNE NFORMATION: � <br /> Name: �-. c. A<� - . A. ���:� ` <br /> Phone (day): � Z • Z�c� . �t},S � <br /> Address: r City:�.�,��,�'�Q j.�q ZIP: '�3�\ <br /> Email and/or Fax _`�� ��� y������ C,t„u-�, <br /> ARCHITECT/ ENC�II�EER (NFORMATION: <br /> Name: �1,'�t c �,��,,�„� <br /> Phone (day): -� ��y <br /> Address: �1 g� Lp � City: C�,�- z� ZIP� �J�J3�`� <br /> Email and/or Fax: C�y�,�� �� � r---k-i�-1�'�`l��, (�FJ-� <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> ❑,New Construction Water Supply <br /> ❑ Single Family with �Residence <br /> �Addition attached garage ❑ Gara e/Accesso Bld <br /> ❑ Accessory Building � Single Famity with ❑ Deckg ry g' � Public Sewer <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> ❑ Other: (specify) ❑ Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑ Warehouse <br /> ❑ Public ❑ Storage �Public Water <br /> "Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review& permits. ❑ Industrial ❑ Private Wel� <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other. (specify) j <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) $ ,� �',v <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />