Laserfiche WebLink
,� � ' <br /> � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: �"1 ._ �(/ 7 <br /> A, PO Box 66 Permit number: <br /> �O`v0 Crystal Bay, MN 55323-0066 Date received: -" <br /> I , . <br /> StreetAddress: ,� Received <br /> � y ,� 2750 Kelley Parkw � � �� p aj n review fee: � - ^70 <br /> �' c.` Orono, MN 55356 �C(�, - C ( <br /> 11kESHOR� Main: 952-249-4600 - " Total Fee: ��.n�"� <br /> Fax: 952-249-4616 www.ci.orono.mn.us '�V1 vvv � <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: ;�r-� n -� ' <br /> Job Site Address: %� _�5 ,,�C��' � �"���� f�'� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ❑ No <br /> /f yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle us service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allo wed. n S.�D S'(r�J��"S� <br /> rz <br /> CONTRACTOR/APP ICANT INFORMATION: „ <br /> Name: �tir� ,�4�,z�.�t� c:1 nG� S c^ S <br /> State License# C'GC�1�J� Expiration Date: 3 i / 7 <br /> Phone: cell /�- /U � 7 office ��S 3- 5 3 7-�ive <br /> Mailing Address: �/ "V ;�co(� •, Cit : -c.lf� �; ZIP: '�,, <br /> Contact Person: T� �� kr c.Q,�el Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: :T� r����'�G:/��/(�SiJNS. C�`/`1 <br /> PROPERTY OWNER INFO MATION: <br /> Name: '� c���/�'I z.��2 ��vr c�Gl� T/'�-S'f <br /> Phone (day): � , - ��{ - ` (�� : <br /> Address: Sal tS�n ;,,�c�,. S01 Cit : �^��°'�l�" ZIP: C � <br /> Email and/or Fax '"� �, ' C;'r�c�,;1 , �� � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �j E���L� {°rTT ��5-�� � <br /> Phone (day): '- _ '��� - ' <br /> Address: . � a^� S'�, �t�.�-- City: E5� ��' ��'`' ZIP: 5� �� J <br /> Email and/or Fax: �"n {�o o+ S'1�,c��<;,c��rl�,f,'� � - C_v M <br /> ,�.';�.,�„-�_��.�.... '1 1 <br /> PROJECT INFORMATION: Descriptic - l ' 'i �'' � "` V"«```� ��T <br /> 1.Type of Project 4.Sewage Disposal 8 <br /> Water Supply <br /> New Construction �ge <br /> Addition �� � • � �Public Sewer <br /> ❑Accessory Building � � <br /> ❑ Relocation <br /> ❑ Other: (specify) w�/�_ ��� • � <br /> �OP.� <br /> **Any earth movement may require �� ❑ Public Water <br /> MCWD review&permits. '�(Private Well <br /> Minnehaha Creek Watershed District(MCWDj <br /> 15320 Minnetonka Blvd �/ � <br /> Minnetonka,MN 55345 � <br /> Phone: 952-471-0590 � <br /> Fax: 952-471-0682 • <br /> www.minnehahacreek.or ���Y'(S <br /> n <br /> Estimated Construction Valuation (ex � � � � ��� <br /> � �;`1,� � �, � �v D <br /> � ���� _ �� ,�1 � . �� <br /> .�� r��� , ��,� <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />