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t r <br /> ' ` City of Orono � G� a �(� <br /> �jl � <br /> Building Permit Application � <br /> for New Structures or Additions <br /> Mailing Address: Permit number: Z�l Z �D 7aJ� <br /> O�,�,�.0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: ���-' " //Z <br /> I � Received b � � <br /> ,a : �, StreetAddress:' �� <br /> �'.�, ° Y�1 Gti`�' 2750 Kelley Parkway � ��Z�r� Plan review fee: � 7(�- y. � r <br /> L9kE8H��`'� Orono, MN 55356 �,�{,. 3 �i'f /2-fJD a2 <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: �-���� � <br /> Job Site Address: .�� ��f�%�'L, �G�/�� <br /> Will this be a Parade of Homes, Rem�delers 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: �� �,� <br /> State License# Expiration Date: <br /> Phone: Q� �� office cell <br /> Mailing Address: � �-G? Cit : ZIP: �'�'' <br /> Contact Person: Applicant is: Contractor / Homeowner �c���ie o�e� <br /> Email and/or Fax: <br /> PROPERTY OWNER�NFORMATION: <br /> Name: � -� �L iC� <br /> Phone (day): C�' <br /> Address: �p�, ��-� � City: ��1���U ZIP: ���/� � <br /> Email and/or Fax ' <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: ����y <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 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) $ / � ��/v� <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />