Laserfiche WebLink
City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: --''���` �� ���� ��`�% <br /> �,i,�,� PO Box 66 <br /> � � Q \ Crystal Bay, MN 55323-0066 Date received: � - `� �``1 <br /> �� <br /> I <br /> ' ~� �. ' StreetAddress:' Received by: ��D <br /> �'�n ° ''� ti�' 2750 Kelle Parkwa <br /> � Y Y � -��'�` r-CC��I�_.(o Plan reviewfee: 'Z� ���� �_��--� lc�� —� <br /> tRkESH�4'� Orono, MN 55356 1'i s�- <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. (P/ease print) <br /> GENERAL INFORMATION: . � <br /> Job Site Address: � d ��� � /p�o �� <br /> Will this be a Parade of Homes, Remodelers Showcase Hom or other Display Home? ❑ Yes ❑ No <br /> lf yes, a specia/event permit is required with Police Department and City Council approva160 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking rs available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: J i�,, Vl�o�q s <br /> State License# ,3 Expiration Date:o��/C� <br /> Phone: a -- v /ol office cell <br /> Mailing Address: / 7 � � / � Cit : ; ZIP: �3 7 <br /> Contact Person: J;rvv ✓Ylv�u s Applicant is: ontractor Homeowner (Circle One) <br /> Email and/or Fax: g� 73�_ -���/S- <br /> PROPERTY OWNER INFORMATI <br /> Name: .S�.�1� ��,,,,•�-� <br /> Phone (day): 7�� cf1���-�� <br /> Address: /j��b �x S�- City� ��/I�rj ZIP� <br /> Email and/or Fax <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 8� <br /> Water Supply <br /> ❑ New Construction ingle Family with �Residence <br /> ddition attached garage ❑ Gara e/Accesso Bld <br /> Accessory Buitding ❑ Single Family with ❑ Deckg ry g� � Public Sewer <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 8�permits. ❑ Industrial �rivate WeII <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 /> Last Updated: 6/22/2009 <br /> - 19- <br />