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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> MailingAddress: Permitnumber: ���Q�'o��Cw <br /> Og,�,�.0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �� -aa-� � <br /> �, '� � �, Street Address:� Received by: �•� • <br /> �',� GtiF 2750 Kelley Parkway Plan review fe <br /> '�9�.EgH�g'F' Orono, MN 55356 � <br /> Total Fee: 5� g <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 ap lications will be returned. (Please print) <br /> GENERAL INFORMATION: ��JO✓a--� �✓^! l�`P <br /> Job Site Address: �ffU _ <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ,�No <br /> /f yes, a specia/event permit is required with Police Department and City Counci/approval 60 days prior to the event. Shuttle bus service wil/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: ��?�ici���� / �-���,�.� ��� <br /> State License# �/�3 Expiration Date: 3-� ��— / y <br /> Phone: �5 Z_ � 7�_S �� � (office) (cell) <br /> Mailing Address: �o <<�� ,� Ci � � ti� �l��<,., ZIP: � <br /> Contact Person: ��/� _ Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: %5'�;/ ����� c�� <br /> Phone (day): r <br /> Address: ��� ���v,�n / City: o�� ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <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 ❑ 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) $ /7S`�� <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />