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City of Orono � � �� .�7 5 <br /> Building Permit Application <br /> for New Structures or Additions <br /> ,.- -- Mailing Address: � _.� <br /> � � PO Box 66 Permit number: <br /> / ,� �� '`� Crystal Bay, MN 55323-0066 Date received: /o�.-� <br /> �� .v._ �;� <br /> `( �i;.�, ti� <br /> �`,` �r �,;, StreetAddress:' Received by: <br /> \��' � ��,'' ti�'�, 2750 Kelley Parkway Plan review fee: 5 (� e�-' <br /> �'�' `i;,t � +a�.'� p,/,, <br /> � t �'�� �-%� Orono, MN 55356 ���a _ �� <br /> `\A�stto4.�. <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: �� �� �� �-� <br /> Will this be a Parade of Homes, Remodelers Showcase Home 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. Shuttle bus se�vice 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: �nvvt� C��;.���, � <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 INFORM T N: � <br /> Name: / �� <br /> Phone (day): �— <br /> Address: l Cit :� ZIP: <br /> Email and/or Fax ` ` ` C <br /> ARCHITECT/ENGIN E I FOR TION: /�� <br /> Name: � (9 <br /> Phone(day): — / � <br /> Address: ,�i l� Cit : / ZIP: g� ��,� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction ❑Single Family with ❑ Residence <br /> ❑Addition attached garage �Garage/Accessory Bldg. ❑ Public Sewer <br /> �.Accessory Building ❑ 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 ❑ 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) $ <br />