Laserfiche WebLink
, .. ' •` r 1 <br /> Cit of Orono � � � <br /> y �-�' � <br /> Building Permit Application � <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �O //- Q O g'�} <br /> ��,0,j�.� PO Box 66 I <br /> �Q O Crystal Bay, MN 55323-0066 Date received: / ( / ) <br /> I� �'s�'� <br /> 1�,a '" z� ` �,�, Street Address:� Received by: <br /> �\�'�, �,. �,"y �ti� 2750 Kelley Parkway Plan review fee: , � <br /> \'� �'S� ��`��� Orono, MN 55356 0'� � r `� Q c� <br /> \j�Esxo�`' <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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 1 ZD 5 D i G��►�SbN STt���T ��o IS� <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 I APPLICANT INFORMATION: <br /> Name: L 1 N Df1 fl. W DT 1 P�1� <br /> State License# Expiration Date: <br /> Phone: _ y��, y-7(�..23G;q (office) 3 d3 -2(p3 -2.��f�� (cell) <br /> Mailing Address: � s i City: Z ZIP: - <br /> Contact Person: �)!�DA YYD?"I PKA Applicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: (;h�aW��;o�, �.� P,.zr-Fh I�nK• n�-t' <br /> PROPERTY OWNER INFORMATION: <br /> Name: J r� f3, /-}rfD Li/�IDA f� . VvOTiPKA <br /> Phone(day): 303 - 2(�3-2��-!n O�PaND <br /> Address: ►205 DJGkElJ501J STx��T City: LWi9YZ!}t"f1�MrY ZIP: 55��/ <br /> Email andlor Fax � a,,U��-;akal � e�rfh��_ . nz-f' <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: 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 /> 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 8�permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) �.Other: (specify) <br /> 18202 Minnetonka Blvd S /�//� <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 �,f ' ,�,���j� <br /> Fax: 952-471-0682 • <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ tf�,� ,��� _ lf; �Dp <br /> Sh�.d G�,��I <br />