Laserfiche WebLink
' City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Z��s_(�(�.7 <br /> QA, PO Box 66 Permit number: � <br /> � r vQ Crystal Bay, MN 55323-0066 Date received: � ` Z Z. :� � <br /> Street Address:' Received by: ��l C <br /> �y� ,� 2750 Kelley Parkw <br /> �� Orono, MN 55356 �'�5��D60`7(� Plan review fee: p � , � <br /> ��'FFS H O��' Main: 952-259-4600 <br /> Total Fee: <br /> � 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: 7�G7 f�j�--�',,�' ;,� � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes,a special event pe�mit is required with Police Department and City Council approva160 days prior to the event. Shuttle bus service will be <br /> required un/ess applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �onv�� ���v✓« S <br /> State License # 02 l/S�� Expiration Date: <br /> Phone: cell („ 1 -��(J-!Q office <br /> Mailing Address: �,/l7 (soh ►'�'I� �v - Cit : (�--o �rn U,c � ZIP: <br /> Contact Person: t f,�� � Applicant is:;�-= ntrac� / Homeowner (Circle One) <br /> Email and/or Fax: e f y��,, qati�,,,r,� ,,K�s , Cc��'t <br /> PROPERTY OWNER I�IFORMATION: <br /> Name: C*��,;� �,,,,�� s <br /> Phone (day): <br /> Address: City: ZIP• <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: Z�p• <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> ter Supply <br /> ew Construction Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence <br /> ❑ Other: (specify) ❑ Multi le Famil /Condo ❑ P � ate Sewer <br /> P Y ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater Public Water <br /> "*Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review 8 permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Othe�: (Specify) ❑ Other(speCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> l <br /> Estimated Construction Valuation (excluding land) $ ,j 7C� l��� <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />