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- � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: <br /> �g,��. PO Box66 <br /> �c� O Crystal Bay, MN 55323-0066 Date received: <br /> ��c=s�,-:. <br /> I _ Received by: <br /> �a �( -�'` a� , Sfreet Address: �, <br /> \�'�n �� �' � ���' 2750 Kelley Parkway Plan review fee: � ,�: r`�, ��'; <br /> Orono, MN 55356 e <br /> �Dggpg'� <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 /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: l�' � ,�fC, �'� d/�C' n ;����� <br /> Will this be a Parade of Homes, Remodelers Showcase Horne 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. Shutt/e 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: ��r= City: ZIP: <br /> Contact Person: �� Appiicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: /�bt� �o�1S� l�i�� .S-�.L�lJi c.-P_l C�C� L <br /> Phone (day): GI S z S�7 ���s <br /> Address: .�„�. (�, �f�x � � City: !'h�"�,� ZIP: s�3��— <br /> Email and/or Fax 9 s-Z t�6� ���–� <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 [�arage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Accessory Building [✓]�Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) G'��-JL.. ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> ""Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review 8�permits. ❑ Industrial ❑ Private Wefl <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) $ ��/ �vv <br />