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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: - ( > <br /> �,�,�. PO Box 66 Permit number: � ��� �-�� < <�4 <br /> � � � Crystal Bay, MN 55323-0066 Date received: �%� � `�.� � � � ` � <br /> a ��� � �, Street Address:' Received by: �'•f� <br /> �1 i __- <br /> �',�, '�� �ti 2750 Kelley Parkway:.��('`I� -�'(t(.`�- - Plan review fee: -�t� ���'�:� �� a '�� l ,- <br /> L9kESHo4'� Orono, MN 55356 `— <br /> Total Fee� �� �,f..,��s� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � 1�� ��%.� <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) '�� ���.`�J`f <br /> GENERAL INFORMATION: � <br /> Job Site Address: � d ��� �� /�/J� , �� <br /> Will this be a Parade of Homes, Remodelers Showcase Hom or other Display Home? ❑ Yes ❑ No <br /> If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the evenk Shutt/e bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: J ' s <br /> State License# ,3 Expiration Date: /(� <br /> Phone: a — � office cell <br /> Mailing Address: / � � / Cit : , ZIP: �3 7 <br /> Contact Person: J;,,,,, yy�,iq s Applicant is: ontractor Homeowner �c�►�ieo�e� <br /> Email and/or Fax: g� 73�� 7�U� <br /> PROPERTY OWNER INFORMAT�Iy: <br /> Name: .s�e.�� /vvr� <br /> Phone (day): '7�_� �t��as-'�7 <br /> Address: ���tj �x S�- City: �/jj/L� 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 ❑ 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 �rivate 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) $ � �5�,).�����':�` ` <br /> Last Updated: 6/22/2009 <br /> - 19 - <br />