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�� �'� �B l . ?.5 <br /> �� <br /> ' � City of Orono G l-�� �� a ��� <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: a���"d/� 7�j <br /> , g,�,���� PO Box 66 � Z <br /> ;/0 ^ Q��,, Crystal Bay, MN 55323-0066 Date received: ! l ��� <br /> .� � <br /> I ��.a�� i '� <br /> ��,,� t�t��,;g,�, ,, StreetAddress;:�.oi�'v !�{7� Received by: �� (:=.-�--- <br /> ��'�, .� "� -0� �ti 2750 Kelley Parkway � ��Z.�/l c P�n r��e�wfee: ��� a �f� �� <br /> �kESH�4'� Orono, MN 55356 �SC�'JJ� (��,�`CI Z�� !".�>ll—�.%14 <br /> Total Fee: ��, ���,,,�,�� ,c� <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 sub �'^�' <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INIFORMATION: / ,, ' <br /> Job Site Address: �� � �O/�2�� �I''✓Y�S 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 rs 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/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: �4��2 �l.L�f'�IV� � <br /> Phone (day): �j-'SZ o��3 _�56 2 G <br /> Address: $OS �'o2es��,�r�� Lr�i�e City: ��i���!;� ZIP: t j 3G 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 8� <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 /> ytt Other: (specify) �n✓ Q� �D ❑ Multiple Family/Condo ❑Warehouse <br /> �,� �Q��i.(�/ ❑ 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 /> Estimated Construction Valuation (excluding land) $ � Od�, o'� <br /> Packet Last Updated: 10-20-2011 <br /> - 20 - <br />