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, � <br /> � q,�' <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> —--� <br /> Mailing Address: Permit number: a�d� �07 <br /> O�O�O CrysBtal Bay, MN 55323-0066 Date received: o / � �Q <br /> � <br /> ��;�r ���� . Received by: �•�• <br /> ,� �` . _ �, Street Address: <br /> '��, � ?�� ~ 2750 Kelley Parkway Plan review fee: <br /> l ' ��' Orono, MN 55356 <br /> `'kESHOg' O <br /> =_- Total Fee: �g�, � <br /> Main: 952-249�600 Fax: 952-249-4616 www ci�orono mr u� <br /> This application form must be completed in full and all required infonnation must be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: � 1 / <br /> Job Site Address: � �' I_ ` �� � <br /> Will this be a Parade of Homes, Remodele wcase 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/APPLI�ANT�NFORMATION: � <br /> Name: �}t�l l (- t' �.�� � �t <br /> State License# � {��;,,�p ��w�m- Expiration Date: l— <br /> Phone: � - � office ( - � - 3 `,t cell <br /> Mailing Address: ct`� Cit : U/' v� C'U Z�P� � � � <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: o- • 5 �, f-(� P• C.v+^^ <br /> PROPERTY OWNER INFORMATION: <br /> Name: �c w�� �5 �/%3���P <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER�FORMATION: <br /> Name: P �'� <br /> Phone(day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8 <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 ❑O�ce/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.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ���C�CJ• GU <br /> Last Updated: 9/29/2009 <br /> - 17- <br />