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. ���� �5� <br /> Cit of Orono �q��� <br /> . y �� <br /> Building Permit Application � � . �� <br /> for New Structures or �4dditions <br /> Mailing Address: � � � ��C�� ' <br /> �,0,�\ PO Box 66 Permit number. �'�� `�- �%' <br /> Crystal Bay, MN 55323-0066 Date received: (�i • , vZ <br /> O�` y-� O 1 Received b �✓_ <br /> �I„� "�� - _ ,, ,J Street Address:' y� - - <br /> ��,�.,t y�;,�j,,��ti�' 2750 Kelley Parkwa r� �?G'/;�-�����5 Plan review fee: �� '�J' � n � � # <br /> \gESHo Orono, MN 55356 ` b�j <br /> -- __, <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: ,���(� ��(�j� C1��9���i�17 ��'���� � <br /> Will this be a Parade of Homes, Remodelers Showcase�Home or other Display Home? ❑ Yes [�o <br /> If 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 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 IN OR ATION: � �/ � <br /> Name: l�l �X�' 'l�' 1��. <br /> Phone (day): � --S ' — <br /> ss: ,�, Cit : ZIP: <br /> Emait and/or Fax e y�� ' /� <br /> --� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <br /> � <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction 0 Single Family with �tesidence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building �ingle Family with ❑ Deck <br /> ❑ ocation ���,(� � detached garage ❑ Office/Commercial ❑ Private Sewer <br /> Other: (specify) Q�1�1�U.l.�t' ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ 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 /> � <br /> Estimated Construction Valuation (excluding land) � '��_ Eju� <br /> W�� �� � � <br />