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City of Orono � <br /> I <br /> Building Permit Application � � �,,J � ��r <br /> for New Structures or Additions �-r�`�'�I ���° <br /> Mailing Address: Permit number: � '� '�f � <br /> �A, PO Box 66 <br /> � �v� Crystal Bay, MN 55323-0066 Date received: ��� —�`O <br /> StreetAddress:' Received by: �'�"�' /(�/- <br /> � ,�- 2750 Kelley Parkway <br /> y�' ��� Orono, MN 55356 Plan review fee: � <br /> lqkESH�� Main: 952-249-4600 Total Fee: �`���g� ' <br /> Fax: 952-249-4616 v��vvv.ci.oron;; mn.us ' r <br /> This application form must be completed in full and all required information must be submi ted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � �;�(.' (L:'�';`'� r'�' ' �� -,� � �^ �,� ���9C� <br /> Will this be a Parade of Homes, Remodelers Showcase" ome or other Display Home? Yes No <br /> lf 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 sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT NFQRMATION: <br /> Name: � ��h��'3� <br /> State License# Expiration Date: <br /> Phone: cell -_� - S . office <br /> Mailing Address � ( "Lr1 �� � r i,��' ' � Cit : ZIP: <br /> Contact Person: . �.,�� � Applicant is: Contractor / Homeowner �c���ieo�e� <br /> Email and/or Fax: -- <br /> PROPERTY OWNER INFORMATION: <br /> Name: � C%'.�1 � ��1 C1 ��i .��C"-�ll <br /> Phone (day): — � .�_ a- 5�" �/� � � � <br /> Address: �.7 �L� C�l.`rr�il ��� �i�N �J��. U'�', City: �,����/1 �� ZIP: 5 ���� <br /> Email and/or Fax - <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <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 � Accessory Bldg./Garage <br /> �Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other:(specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> *"Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑ Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) ❑ Other(SpeCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ - <br /> Packet Lasf Updated: August 2015 <br /> Page 21 <br />