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. City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: permit number: �5'" L�U/d z- <br /> �Q A> PO Box 66 <br /> l V C stal Ba MN 55323-0066 � Z 3—/--�j- <br /> � �Y Y� Date received: <br /> StreetAddress:' ` Received by: � <br /> y� ,� 2750 Kelley Parkw ��y Plan review fee: � <br /> c.` Orono, MN 55356 �(�l�'��� 2 2 � � - <br /> ��'�ESHOR� Main: 952-259-4600 Total Fee: <br /> 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. (Please print) <br /> GENERAL INFORMATION: ;2 i - r � Q ��� S�'�e� <br /> Job Site Address: �SZ V1 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes `� No <br /> If yes,a specia/event permit is required with Police Oepartment and City Council approva/60 days prior to the event. Shutt/e bus service wtlI be <br /> required un/ess applicant demonstrates sufflcient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANTINFORMA IQN � � <br /> Name: � <br /> State License# 2 Expiration Date: � <br /> Phone: cell � Z.�2 -8 Z office Z, �'�l2 <br /> Mailing Address: � Cit : � ZIP: 1 <br /> Contact Person: (Vl L�G� ��v Q� Applicant is: ontractor / Homeowner �c����o�> <br /> Email and/or Fax: S v\C'�vt��lt L�A yc.�po . CS�,rY1 <br /> PROPERTY OWNER INFORMATION: <br /> Name: �� <br /> Phone(day): 2 - ' <br /> Address: :'Cd�vy`�O t 'Q r�. Cit : 0�� ZIP: <br /> Email and/or Fax � Q . �p�n.� <br /> ARCHITECT/ENGINEER INFO ATION:- (�� S�� � <br /> Name: �� G v1 IJ <br /> Phone(day): - <br /> Address: Q 1 Cit : � VLQ ZIP: ��'�( <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> '�,New Construction �t]Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage Residence �.Private Sewer <br /> ❑Other: (specify) ❑Multiple Family/Condo � Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> '*Any earth movement may require ❑Commercial ❑Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other: (specify) ❑Other(speCify) <br /> 15320 Minnetonka Btvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � � �, �� . ��� <br /> Packet Last Updated: January 2015 <br />