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City of Orono <br /> , Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: ; � � - ' � �� <br /> g,0,�. PO Box 66 Permit number. � � /�=- � �. �, - ��; <br /> O Q Crystal Bay, MN 55323-0066 Date received: ��' 1� <br /> . <br /> '' ---- Received � <br /> t a ' -:: a. , Street Address:' . � _ __ <br /> .;-, • r�� - <br /> ,,ti 2750 Kelley Parkwa� ��� r,C' S/3 Plan r iew fee: � L , a� � <br /> \t � fi w�' Orono, MN 55356 ----- - <br /> ��Ko. <br /> _- T al Fee: <br /> Main: 2-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This ap �cation form must be completed in full and all required inf mation must be submitted. <br /> Incomplete applications will be returned. lease print) <br /> GENERAL INFORMATI /� <br /> Job Site Address: �� ,f�1�. S�'� �/�v n �s��� <br /> Will this be a Parade of Homes, emodelers Showcase Home o other Display Home? ❑ Yes No <br /> If yes, a special event permit is required with ice Department and City Council app val 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates suffrcient -site parking is available. Non- rmitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATIO ' <br /> Name: <br /> State License# Expiration Date: <br /> Phone: ffice cell <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: plicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> � <br /> PROPERTY OWNER INFORMATION: <br /> Name: L� o/ISu �in -C.�'t�/��� C�L G <br /> Phone (day): C - �, `� <br /> Address: ' , s Ci � !?'��"�t� ZIP: 5�3�,� <br /> Email and/or Fax Z — � <br /> ARCHITECT/ENGINEER INFORM ION: �� ��� `' ,�`�`���. ��������� �� <br /> Name: <br /> Phone (day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATI N: <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4. Sew e Disposal 8� <br /> Water upply <br /> ❑ New Construction ❑ Single Family with ❑ Residence � <br /> ❑ Addition attached garage [�Garage/Accessory Bldg. ❑ Public Se er <br /> ❑ Accessory Buildin [✓�Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewe <br /> ❑ Other: (specify) �'�A'(-e-- ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "`Any earth mov ment 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) $ /�/ �vv <br /> ��ss e� � � C3 rh� rL-� /v C�c� �/��' r�-n o.�r v..i � c r y ?�°/L <br />