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_ . , /, � � <br /> � <br /> � (,�,r. � � <br /> � z��� c� �.,, �5 <br /> City of Orono <br /> � <br /> Building Permit Application <br /> for New Structures or Additions <br /> /�O�_\ Mailing Address: Permit number: ��b� R <br /> / PO Box 66 <br /> � � �\ C stal Ba MN 55323-0066 Date received: / <br /> �� O .� O�� ry v, � a0/� <br /> � �, <br /> ��'�� ��'�'����,� s.'� Street Address:' Received by: <br /> ��'� �� '���,y;"�,� �� 2750 Kelley Parkway Plan review fee: �v� .(p <br /> t�kESH j Orono, MN 55356 p�U�O- �0�� <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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: <br /> Will this be a Parade of Homes, Remodelers Showcase Home 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/APPLICANT INFORMATION: � <br /> Name: �� �{�Oc�� ��"�r'c,�c�c�� `� <br /> � - �. <br /> State License# Expiration Date: <br /> Phone: _ < < � _ c�v office � � �.� - `� �j U 3 r i '• <br /> cel I <br /> Mailing Address: G-2��� (�ti, Cit : __ s�, �� ZIP: ���'„-- <br /> Contact Person: `j ��,��._� �(c,��c,-- Applicant is: ntracto� / Homeowner (Circle One) <br /> Email and/or Fax: ___�-�` <br /> PROPERTY OWNER INFORMATION: <br /> Name: �' ��...� � <br /> �� ✓�c _� r� �� <br /> Phone (day): <br /> Address: 'Z� C� C,,�v��-- City� r�CZ-U �� ZIP� <br /> Email and/or Fax <br /> ARCHITECT/ ENGIN�INFORMATION: <br /> Name: � ��-���� <br /> Phone (day): <br /> Address: Cit : 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 ❑ Gara e/Accesso Bld <br /> ❑Accessory Building ❑ Single Family with ❑ Deckg ry g� ❑ Public Sewer <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> ❑ Other: (specify) ❑ Private Sewer <br /> ❑ 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) $ i �, O(70 <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />