Laserfiche WebLink
. •�Cv � G������ <br /> • "f" r V"'�� �( <br /> -�e <br /> City of Orono <br /> Building Permit ication <br /> for New Stru res or Additions <br /> Mailing Add s: Permit number: z. O – � r( <br /> ��,0,�`� P ox 66 <br /> ��\ O\,1 rystal Bay, MN 55323-0066 Date received: <br /> � ��g�- ._ 'I . Received by: <br /> ,� � �, � Street Address: � <br /> 1 r �' �^�> <br /> �� ' ;'��, �,� �t01��` 3•a''��750 Kelley ParkwaY C� L IL� �5� �n review fee: ��� ( — ��f <br /> t'�kESKog,� rono, 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 appiications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: : 3�0 ���c 5;��. ���N� �N� �5 3=� eo <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. 5hutt/e bus service will e <br /> required unless applicant demonstrates sufficient on-site parking rs available. Non-permitted events will not be al/owed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: g;�.,a��L 8- 1�uf'�i:;,.N.aa.y <br /> State License# 3`�2 Expiration Date: � �3t 20�2 <br /> Phone: �I��� �-�3-- Sy ��r (office) ( b i�) H��{ .-5�`� (cell) <br /> Mailing Address: • �• M.atv-° f�►�A �va• Cit : z�'tA ZIP: �3�3 <br /> Contact Person: „�;��. �;�v.�,;�.sZ�� Applicant is: ontracto / Homeowner (Circle One) <br /> Email andlor Fax: ��;�, � =,T�;,,.�,-���;�,1„�„�.,.,,c.��„� <br /> PROPERTY OWNER INFORMATION: <br /> Name: i�i�^��ai��' C�t�L� <br /> Phone (daY): ����.� '�e,. .- b��� <br /> Address: °�3=:ic �uy� '.�;ti?-�T City: 6:�or.>u ZIP: �+��f� <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: ��►c r1��-+-�c c�R'-�.4�r e✓� ��r�vF' � t'��rc� GS���� � <br /> Phone (day): �,�� Z��,r- ��7� <br /> Address: ��3� at:o�rv��'u���c� B:rv�-. City: w9iY��-s-R ZIP: ��3`i V <br /> Email andlor Fax: �,ztt+�� �J {-d.«.c.ttsy�:r�:�.:.���- :-a��n <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 /> '�Addition 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�j i ,,,,-�p,�vc.� <br /> Last Updated: 4/26/2011 <br /> - 19- <br />