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�ity of Orono <br /> . � Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: <br /> O�j,O,�.O PO Box 66 � <br /> Crystal Bay, MN 55323-0066 Date received: l� .� //Z <br /> � ,� ��' � �, StreetAddress:' Received by: c:�� <br /> �'.�, y� Gti`S' 2750 Kelley Parkway Plan review fee: � �'(� �/. �r <br /> ��kESH�4'� Orono, MN 55356 <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 a plications will be returned. (Please print) <br /> GENERAL INFORMATION: 3�� � ,.� <br /> Job Site Address: ./�(,����, �'� i4`'�� <br /> Will this be a Parade of Homes, Remtidelers Sh wcase Hom 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/APP ICANT INFORMATION: <br /> Name: r�. � �,� <br /> State License# - Expiration Date: <br /> Phone: �� � �� office cell <br /> Mailing Address: �C,' Cit : ZIP: �- ' <br /> Contact Person: Applicant is: Contractor / Homeowner �c���ie o�e� <br /> Email and/or Fax: <br /> PROPERTY OWNER FORMATION: <br /> Name: •-� � �.�..6,L"� <br /> Phone (day): <br /> Address: ��-� � City: �jt,����,r'✓ ZIP: ���% � <br /> Email and/or Fax ��� I 7��-�=r�1�� ��' �_�, �_ t= _�> �.,L�' �'���� �'' �-�:�:��, � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ��� ,: <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 & <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 ❑ 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) $ / ��--��/'G�� , <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />