Laserfiche WebLink
City of Orono '' <br /> .; <br /> Building Permit Application �� � <br /> for New Structures or Additions <br /> Mailing Address: <br /> �Q A r PO Box 66 Permit number: p20�3 "� 8 '�j <br /> `VQ Crystal Bay, MN 55323-0066 Date received: �"�� <br /> Street Address:' Received by: ►�'l <br /> 2750 Kelle Parkwa �3 � <br /> yF � Y y Plan review fee: �• c3 <br /> c? Orono, MN 55356 <br /> `�'FESHO�� Main: 952-259-4600 Tota1 Fee: ���3-OD �9'� <br /> Fax: 952-249-4616 ����a;�;r � ,, u� <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: ���d���,r J���, ,�,c� h� � <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 approva160 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 1 APPLIC NT INFORMATION: <br /> Name: � ��r,s� c�r � <S'o ,���' <br /> State License# �} p � �� � Expiration Date: ��1�/� <br /> Phone: �cell) ���� �-.Qn - �D�,,� (office) '71_q��9J'3� �� 7/i_ <br /> Mailing Address: �. o �,�� �n -� :� City: ��.��a,, „ ZIP: ,;j���3�? ,� <br /> Contact Person: Applicant is: ,Contractor / Homeowner (Circle0ne) <br /> Email and/or Fa �' -7(0�Ta — �/ G' <br /> PROPERTY OWNER INFORMATION: <br /> Name: D c�� �i �/1�� �S �c?� n t' i� <br /> Phone (day): �,/a� 3 0�3 — �.� f(� <br /> Address: � �,� p ��y ,�, w,�' Go 1.�,,,� City: Q r� ��, ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: 4f, l� . �..�sL9 r� — l.clqr'r� /� Ru7-�2a�� r <br /> Phone (day): q�a — �13v— ����6 <br /> Address: ,� � y s. ,7 �'✓ S 7" City: ��,�-„�s ZIP:�"��3�f,� <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 /> 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 /> � b <br /> Estimated Construction Valuation (excluding land) $ �� 6�d. <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />