Laserfiche WebLink
, �,���- <br /> ' a ;t�i�D�( <br /> City of rono <br /> Building Permit Application <br /> for New Structures or Additions g9.9� <br /> Mailing Address: pCr —0��p�.�" <br /> Og,�,�0 PO Box 66 Permit number: B <br /> Crystal Bay, MN 55323-0066 Date received: <br /> I �;�;�T_ ' <br /> 'a ��� ���;;,, a, I StreetAddress:' Received by: <br /> �'�c, '^ �� � 2750 Kelley Parkway Plan review fee: .57, 'S 3 h <br /> r�4,�ESKpg�'4' Orono, MN 55356 �q� —0ob13 <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 fufl and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ��S 5 �t�,�- �Z,J�� � <br /> Will this be a Parade of Homes, Remodelers Showca es Fiome or other Display Home? ❑ Yes ❑ No <br /> If yes, a specia/event permit is required with Police Department and City Counci/approva/60 days prior to the event. Shuttle bus service wil/be <br /> requrred unless appficant demonstrates su�cient on-site parking is avai/able. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: 1� <br /> Name: ���.�--�--`,�-�tNy �c�U� �� � t <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 INFORMATION: < <'<< e �'� `o�2 "(,� l ^� U 0 Z <br /> Name: �ti o .,..�f � j�' � <br /> Phone (daY)� �jsz - Y � ?—�4"� 7� - <br /> Address: ( �g� /_�;� (Z,'�r� ,� �• City: Q�G�`--> ZIP: �j����� <br /> Email and/or Fax -���j q�--� � ��}�,,, , � �,� <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 /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑ Residence <br /> ❑ Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> �Accessory Building �p�'�2 ��.�J ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> ""Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review& permits. ❑ Industrial i ❑ 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) $ z��J o�- <br /> Last Updated: 6/22/2009 <br /> - 19 - <br />