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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: _ 1 9 <br /> .�Q AV- PO Box 66 'ermit number: �a t 8,OU <br /> Crystal Bay, 553 3-0066 Dat: received: 7- 2, -/ 4- <br /> Street Addr.ss:' 17 5 I, 5 F <br /> 7 Rec-ived by: rY] &P <br /> 2750 elley Parkw an review fee: `7140 5 35 <br /> L Oron. MN 55356 <br /> o?C' 0 <br /> t�kESHO�� Main: 952- � <br /> '°-4600 Total Fee: M- 0 1-9$' <br /> Fax: 952-249-4616 www.ci.orono.mn.us 40N <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: (S(oc Fr►tr Vl&cJ ( 41-Ale L#q-rye <br /> Will this be a Parade of Homes, Remodelers Showcase Hoe 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. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: O w Nfg- <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: ZIP: <br /> Contact Person: tractor / Homeowner (circle One) <br /> Email and/or Fax: <br /> PROPERTY OWN <br /> Name: <br /> Phone (day): <br /> Address: Drub-o ZIP: 3 G <br /> Email and/or Fax <br /> ARCHITECT/EN( <br /> Name: <br /> Phone (day): Atte <br /> Address: ► 14.Ga.l ZIP: 5310 <br /> Email and/or Fax: C )-t q <br /> ARCHITECT/ EN( (j� <br /> Phone ) n ""�� <br /> Phone (day): IvIC/ <br /> Address: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFOI <br /> 1.Type of Projectn >e 4. Sewage Disposal& <br /> �y ` Water Supply <br /> ❑ New Construction / dg./Garage <br /> ❑Addition [.Public Sewer <br /> -gaccessory Buildin 1 ercial <br /> ❑ Relocation 0 Septic <br /> ❑ Other: (specify) _ II(s) (Compliance certificate <br /> ater may be required) <br /> **Any earth moveme <br /> MCWD review&per 0 Public Water <br /> Minnehaha Creek Watei �) <br /> 15320 Minnetonka Blvd; [Private Well <br /> Phone: 952-471-0590 <br /> www.minnehahacreek.o <br /> Estimated Construc <br /> Packet Last Updated: January 2016 <br /> Page 21 <br />