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' ,r <br /> � . . + City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: aO/�_ <br /> /�.+0,�� PO Box 66 Permit number. 6�� 7� <br /> /0 ��\ Crystal Bay, MN 55323-0066 Date received: ���Z���� <br /> �,,, 1 <br /> I ��h��'� I Received b ,,� � �L.— <br /> l� `��' o. Street Address: o�f�U ( '7�f Y� �' �' <br /> � �.:��� � � Y <br /> ��,n �"'� �ti ' 2750 Kelley Parkway � ��Z�l l � P�n�r�e�w fee: ��� � �f�• �9� <br /> L�'kESH04'� Orono, MN 55356 <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 /> Incompfete applications will be returned. (Please print) <br /> GENERAL INFORMATION: �D � �OrP �� ��rns ! w , <br /> Job Site Address: UV <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 Counci!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/APPLICANT INFORMATION: <br /> Name: <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER I FORMAT�N: <br /> Name: �l�jC2, �GG�lZC�IV� � <br /> Phone (day): �SZ �l,�3 �56 2 G <br /> Address: $OS �"o/us� �.�r�c' �i�i�� City� ����� � ZIP� t j�G ly <br /> Email and/or Fax �c, � �! ,'L ,-+-� <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 & <br /> ❑ New Construction m le Famil with Water Supply <br /> [�,5� g y � Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. [� Public Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> � Relocation � , detached garage ❑ Office/Commercial <br /> Other.(specify) �+v✓ Q� �� ❑ Multi le Famil !Condo ❑ Private Sewer <br /> p y ❑Warehouse <br /> Ce� �,��i(�f ❑ 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.m innehahacreek.or <br /> Estimated Construction Valuation (excfuding land) $ 2,�0� Od�J� o�� <br /> Packet Last Updated: 10-20-2011 <br /> -20 - <br />