Laserfiche WebLink
� � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: I! Permit number: �9- B D`{9� <br /> �\ PO Box 66 <br /> � Crystal Bay, MN 55323-0066 Date received: �-/7-� <br /> %; � �:, ��' �I�YJ <br /> ,' �'� !'' . Received by: <br /> ,� ��i :� �, Street Address: `�4�, 8 9� �- <br /> �`;'�F, ' �,��;j� �ti�� 2750 Kelley Parkway Plan review fee: � <br /> LyX,EgH04,�" Orono, MN 55356 �i r� �, o?D09-05�9 <br /> � t ��Fee: �: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us ✓ � �"(�- , ��J`� <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: �� �-�i'�i `�/-�� ��� � <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 su�cient on-srte parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: '!y�c � S.� r�>''� <br /> State License # Expiration Date: <br /> Phone: yS� �/?/ �y 93 (office) �C�5 >�`/ Sl� / (cell) <br /> Mailing Address: �� ��� ,,,o�� � City: _ ZIP_ <br /> Contact Person: �J7�/f�",�Fi4iL ;� �v,n,�,;y r�pplicant is: Contractor / Homeo� (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: "��� lT S� ,�,�,-rc <br /> Phone (day): �>s�- �/� I �yy 3 <br /> Address: �.Fr� �<,�,�p,�v �,L �,�.J City: t�'2 v it,v ZIP: S`�-3�j t <br /> Email and/or Fax �s��l�,/7 i � Y �i S� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: /7,��c� ��i � <br /> Phone (day): �I S�� �'7�v �222 <br /> Add ress: �.2�> f�i�n�-,-a r}✓-� City: �-�✓��1 L .��t,� ZI P: j���'� <br /> Email and/or Fax: �:� ,� ��z �C" C Z�-F <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction •�&i�fe-F�r�i+y with �Residence � <br /> �Addition attached garage ❑ Garage/Accessory Bldg. �Public Sewer I <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer ' <br /> ❑ Other. (specify) ❑ Multiple Family/Condo ❑Warehouse i <br /> ❑ Public � ❑ Storage � ❑ Public Water � <br /> "'Any earth movement may require ' ❑ Commercial ❑ Other(specify) �i <br /> � MCWD review 8� permits. ❑ Industrial i ❑ Private Well ; <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other. (speCify) � '� I <br /> � 18202 Minnetonka Blvd ! i I <br /> Deephaven, MN 55391 � <br /> I Phone: 952-471-0590 � <br /> i Fax: 952-471-0682 I ! <br /> i www minnehahacreek or I I '' <br /> Estimated Construction Valuation (excluding Iand) $ �Q ,p0� — <br /> .� <br /> Last Updated: 6/22/2009 <br /> - 19 - <br />