Laserfiche WebLink
� • Cit of Orono � <br /> • y j ��� a� � <br /> Building Permit Application ��1�� <br /> for New Structures or Additions <br /> MailingAddress: Permit number: o2O/a 'D ��`� 3 <br /> /�� .,�. PO Box 66 <br /> � O Crystal Bay, MN 55323-0066 Date received: �(-2� ��Z- <br /> J �'�"'"°` Received b �G S <br /> ll a, '"�`�� �-:= ,, Street Address:� y� <br /> �� ,�� ti� 2750 Kelley Parkway Plan review fee: � 5„ <br /> \'� �E, � 4,� Orono, MN 55356 <br /> R�--_9H0=w �.o� a -c���.o a. <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: �� �r��n �0 1 <br /> Job Site Address: � lJ�' � L <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/AP LICA � IN�OR ATION: <br /> Name: -�_k \ �, t i���Y"� <br /> State License# O(Sq2- Expiration Date: 3-3� - ���-�- <br /> Phone: - 3 Z6 office - �Z- OS 8 cell <br /> Mailing Address: �', Cit :�( 4.�. q( ZIP: SS�{Z.'7 <br /> Contact Person: ' ,Q,e Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: i,� C' ,Go <br /> PROPERTY OWNER INFORMATION: <br /> Name: '�v �a t <br /> Phone (day): 12_- - <br /> Address: 6 � p� Cit : ��t6'— ZIP: � <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATIO . <br /> Name: <br /> Phone (day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction j�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 <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �,��36 <br />