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! � <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> ���� Mailing Address: Permit number: / — �aa O <br /> �v�.(��\� PO Box 66 <br /> Q �:\ � ,, Crystal Bay, MN 55323-0066 Date received: <br /> '�i�e;-1. <br /> ,� �'�"'�;�-�;' i� Received b <br /> �u Street Address:' Y� <br /> �c� � "����`"��,, �� 2750 Kelle Parkwa /�p�,S� �j,� <br /> L , � o Y Y Plan review fee: <br /> qkESHO�� Orono, MN 55356 _ <br /> Total Fee: �� /� —�� <br /> Main: 952-249-4600 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: <br /> Job Site Address: ?-�j� � �� ��a <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �'No <br /> If yes, a specia/event permit rs required wrth Police Department and City Council approval 60 days prior to the event. Shutt/e bus service will be <br /> required unless applicant demonstrates sufficient on-site parking rs available. Non-permitted events will not be allowed. <br /> CONTRACTOR/ LIC NT INFOR�q.�p� <br /> Name: � --a�a� �— <br /> State License# ; Expiration Date: <br /> Phone: —� — (office cell) <br /> Mailing Address: q fl tv .S'T�. Cit : ZIP: �S')Z� <br /> Contact Person: Applicant is: o trac / Homeowner (Circle One) <br /> Email and/or Fax: � —g Z <br /> PROPERTY OWNER INFORM N: <br /> Name: � c� .�- "f- �R C i <br /> Phone (day): L 33�} 'SC�� <br /> Address: Z S' �pX ��- City �12G(�CJ ZIP� �,3 S� <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: _ Cit � ZIP� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & <br /> ❑ New Construction Water Supply <br /> ❑ Single Family with ❑ Residence <br /> ❑ Addition attached garage ❑ Gara e/Accesso Bld <br /> ❑Accessory Building ❑ Single Family with ❑ Deckg ry g� ❑ Public Sewer <br /> ❑ Relocation detached garage ❑ Office/Commercial �Private Sewer <br /> � Other: (specify��-�Q,ovr� �cY� ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> '"`Any earth movement may require ❑ Commercial ther(specify) <br /> MCWD review&permits. ❑ Industrial �s �rivate Well <br /> Minnehaha Creek Watershed District(MCWD) �her: (specify) <br /> 18202 Minnetonka Blvd �� <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or p <br /> Estimated Construction Valuation (excluding land) $ I � � <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />