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� � � <br /> � ��- � <br /> � <br /> , <br /> City of Orono /� <br /> Building Permit Application � <br /> for New Structures or Additions � �� <br /> �O� Mailing Address: I Permit number: ' .5-7�� <br /> .¢, ,�.� PO Box 66 <br /> ;O O Crystal Bay, MN 55323-0066 Date received: � �� <br /> '� � �;�.� `� Street Address:� Received by: i/-[ <br /> � �� I , � <br /> i',;J. ��e.:::;y <br /> �V'� ' � �:�_ ti�� 2750 Kelley Parkway Plan review fee: �' ' � <br /> �ty�� , �o`�¢�v��� Orono, MN 55356 �� � � � <br /> Esx �7 9 po�o°�' ,,� <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � �� ��� ���a0' <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: ���'aO ��C ���" <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 Councif approval 60 days prio�to the event. Shuttle bus service eGill be� <br /> required unless applicant demonstrates su�cient on-site parking rs available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMAT N: <br /> Name: � �� <br /> State License# Expiration Date: <br /> Phone: (office) (cetl) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email andlor Fax: <br /> PROPERTY OWNER INFORMATION: , . <br /> Name: I�lvl�. �.; �.f��G�� �t2 `'d1O a'C,��3 �F. <br /> Phone (day): � ��' - �` - _ <br /> Address: C7 � Cit :�G� Gl, 1 ZIP: �� Cl ' <br /> Email and/or Fax ;� �, � Q C� � � <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P: <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 /> ❑ Additfon 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) ��'utii� `l�l'`��-- ❑ Multiple Family/Condo i ❑Warehouse I <br /> � ; ❑ Public ❑ Storage ❑ Public Water <br /> I "`Any earth movement may require ' Q Commercial �Other(specify} i <br /> � MCWD review& permits. '�]�ndustrial ❑ Private Welf I <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other. (SpeCify) i J1����;��L C�,�;� I <br /> 18202 Minnetonka Blvd i ` `_ ,,.�� �}Uc� _ <br /> Deephaven, MN 55391 � V� <br /> Phone: 952-471-0590 I ,�� �„ti1C�CL�(�� i <br /> � Fax: 952-471-0682 � � �� <br /> www.minnehahacreek.or � <br /> Estimated Construction Valuation (excluding land) $ `�' �-}�i�l [:L S <br /> Last Updated: 6/22/2009 v� <br /> - 19 - ������ <br />