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� <br /> �� � <br /> � � � <br /> City of Orono 02�� <br /> Building Permit Application <br /> for New Structures or Additions <br /> -- Mailing Address: Permit number: 020/oZ -�7 <br /> ,,,;-:¢,�,�:�:` PO Box 66 <br /> '-O Q��', Crystal Bay, MN 55323-0066 Date received: 7 "�U-/ <br /> �r <br /> '� �"�r J� . ,,,i . Received by: <br /> � , .,of G <br /> Street Address: <br /> ����� �9��xY �ti,� 2750 Kelley Parkway Plan review fee: ,v1 / /�. �7 <br /> �t '�1�'�,r�*v:�� Orono, MN 55356 �!�_ �7 <br /> '�_`�$E6HQ4-% Z <br /> _-= Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 r��� orono r7in 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: I�� <br /> Job Site Address: � 2� �c}�C ��C' r <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 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;I r <br /> Name: �v�1� '' � ��r ilG�l <br /> State License# ���Q/(� Expiration Date: � � ! � <br /> Phone: 9 " office cell <br /> Mailing Address: �/'- �� ,J�t'1� Cit : �I�) ZIP: ���( <br /> Contact Person: w' Applicant is: Contr ctor / Homeowner (Circle One) <br /> Email and/or Fax: •v, �, � � h � , , v�•� <br /> PROPERTY OWN R INFORMATI N: <br /> Name: � �� �Xs M uXh �a r� <br /> Phone(day): <br /> Address: '7� City: ZIP: �J��p <br /> Email and/or Fax -�r -�� <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& <br /> Water Supply <br /> ❑ New Construction ❑ Single 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 ❑ 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) $ Y/� u��"t�"� <br />