Laserfiche WebLink
- , � � <br /> 2 <br /> tJ�'� i,Q 1 <br /> 1� <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> � Mailing Address: Permit number: 60Q���aS� <br /> ��.���,,� PO Box 66 <br /> I � „�s i Q\\' Crystal Bay, MN 55323-0066 Date received: ,� � p <br /> 1 <br /> � a �'��`�`x� a,� Street Address:� Received by: � <br /> �. , ��:,_ ti <br /> ��; 2750 Kelley Parkway Plan review fe � <br /> �����H� Orono, MN 55356 <br /> Tota ee: f0� �� �� � <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 mus�be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: �/ , <br />• Job Site Address: -S y c> 5 �ti�'� jr � �/4 �•�Q, <br /> Will this be a Parade of Homes, Remodelers Showc e Home or other Display Home? ❑ Yes o <br /> If yes, a special event permit is requrred with Police Depar7ment and City Council approval 60 days pnor to the event. Shuttle bus service w'� <br /> required unless applicant demonstrafes sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: T� �,�, L ���G,� <br /> State License# Expiration Date: <br /> Phone: �i� -Zo�>. /7Zc� (office) Cp 1 Z �� `3 /���� (cell) <br /> Mailing Address: v ,� c�. � Cit : ;,ti��;� � . ZIP: <br /> Contact Person: _i� s,,,, /_�,rsc •, � Applicant is: Contra or / wn (Circle One) <br /> Email and/or Fax: � �� .t: •�. c� , ��,, <br /> PROPERTY C�WNER INFORMATION: <br /> Name: ��r.�,�� <br /> Phone (day): <br /> Address: _ City� ZIP� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Cit � ZIP� <br /> Email andlor Fax: <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 �arage/Accessory Bldg. `�Public Sewer <br /> �.Accessory Building �, � ❑beck � <br /> ❑ Relocation detached garage ❑ Office/Commercia! <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse � Private Sewer <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 I_�](' �„}� <br /> Fax: 952-471-0682 �� IT <br /> www.minnehahacreek.or ���L .�� <br /> Estimated Construction Valuation (excluding land) $ <br /> -20 - <br />