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• � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: � <br /> �/��,�. PO Box 66 Permit number: — <br /> \ Crystal Bay, MN 55323-0066 Date received: �-- / <br /> �� �'� �' �� Received by: • U� � <br /> 1�„a '�`''� '� �,�, Street Address:' <br /> ��'�c, � �� Gti/ 2750 Kelley Parkway Plan review fee: <br /> �t �''�� :�`� � � Orono, MN 55356 <br /> �EsxoS''/ <br /> '---- Total Fee: �,0, / � <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: �'���Z 7 �/�/i.�,1, (� <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 Counci!approval 60 days prior to the event. Shuttle bus service wil!be <br /> requrred unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR 1 APPLICANT INF�},RMATION: r <br /> Name: ��- �y�}-��-�/,il�1h� ,ZP1C. <br /> State License# Z�k,��'"7 57 Expiration Date: �, (�; � Z <br /> Phone: (� , ��� office .r, cell <br /> Mailing Address: 2Z 1 �+f1= Cit : ZIP: `_ ?i,,;� <br /> Contact Person: .N Lc,t ' App(icant is: ntractor Homeowner (Circle One) <br /> Email and/or Fax: � S� <br /> PROPERTY OWNER INFORMATION: �i^� <br /> Name: �il['.l'1['�'►�(� � �..�C.1YIYl .Y 1 <br /> Phone(day): CS7 ,�/� , Z'�'j� <br /> Address: ��Z, ��}�r,��,�, C�/ City: ���,�j ZIP: <br /> Email and/or Fax -- <br /> ARCHITECT/ ENGINEER INFfJRMATION: <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 & <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑ Residence <br /> ❑ Addition , attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building /' ,,.i�� ❑ Single Family with ❑ Deck <br /> ❑ Relocation ��� detached ara e <br /> S g g ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other. (specify) �- � ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Pubfic ❑ 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 /> Estimated Construction Valuation (excluding land) $ ( , �{- J <br />