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' � io���n� <br /> City of Orono � a . DD <br /> Building Permit Application �� <br /> for New Structures or Additions <br /> O�O j�O Ma��iP�ABd�d ss�s' Permit number: G�D��-� {�� <br /> �V Crystal Bay, MN 55323-0066 Date received: �'Zq��� <br /> '� Received b ��.5 <br /> � ` s. StreetAddress:' Y� <br /> ��t �,�`� 2750 Kelley Parkway Plan review fee: �'j ,g�p hv <br /> '9IfEsHp4�' Orono, MN 55356 a �OD �r��/'�, <br /> -- Total Fee: C1��"" • <br /> Main: 952-249-46�0 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: r � �Q <br /> Will this be a Parade of Homes, Rem delers Showcase Home or other Display Home? ❑ Yes �No <br /> If yes,a specia!event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service wil e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INF RMATION: � <br /> Name: ' � � � � �.t T <br /> State License# Expiration Date: �-3� �2n�[' <br /> Phone: - office cell <br /> Mailing Address: Cit : ZIp: •S y. <br /> Contact Person: Applicant is: ontr cto / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER�n ORM TION; ` I_ �S <br /> Name: � � <br /> Phone(day): S . <br /> Address: Ci : ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATI • <br /> Name: ���°� h��C�(7l/' <br /> Phone(day): <br /> Address: City: ZIP� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8 <br /> New Construction Water Supply <br /> �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 <br /> ❑Other: (specify) ❑ Multiple Family/Condo ❑Warehouse ❑ Private Sewer <br /> ❑ Public ❑Storage ❑ Public Water <br /> "Any earth movement may require ❑Commercial �Othgr(spe 'fy) <br /> MCWD review 8�permits. ❑ Industrial `.�� ❑ 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) $ <br /> Last Updated: 6/22/2009 <br /> - 19- <br />