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Cit of Oron� � �/ <br /> � Y �i� 5 <br /> . . � . � ��. � <br /> Buildin Permit A lication �� <br /> 9 pp . � <br /> for New Structures or Additions <br /> �_—_ Mailing Address: Permit number: o�O�I—D d 77� <br /> /4.,�,�.\ PO Box 66 <br /> 0\ Crystal Bay, MN 55323-0066 Date received: �Z "J <br /> ��� �'��s_;'��, ��� Street Address:' Received by: � ✓�..5 <br /> .�n ��� �ti 2750 Kelley Parkway Plan review fee: ��6.3�( 2� <br /> \�kE5Hog'� Orono, MN 55356 ao/�O O 77G // <br /> ��-- <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: �ZC� �e��an�� �j}-, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> lf yes, a specia/event permit is required with Police Department and City Council approval 60 days prror to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permifted events wilf not be allowed. <br /> CONTRACTOR/APPL�lCA INFORMAT40N�� <br /> Name: � �(`tl <br /> State License# �S°�7 Expiration Date: O(Z- <br /> Phone: �— - 2- � office - (cell <br /> Mailing Address: Cit : -�, ZIP: Z'� <br /> Contact Person: v,ti Applicant is: Contractor / Ho owner (Circle One) <br /> �- - _ _ <br /> Email and/or Fax: ` ' � <br /> PROPERTY OWNER INFORMATION: <br /> Name: �,,� ` <br /> Phone (day): �- 0 -Z -Z� <br /> Address: a,, Cit : �- ZIP: <br /> Email and/or Fax <br />� ARCHITECT/ ENGINEER INFORMATION;> <br /> Name: �' <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email andlor Fax: <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> ,�❑ ew 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 8�permits. ❑ Industrial <br /> ❑ 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) $ �pp <br /> Last Updated: 4/26/2011 <br /> - 19 - <br />