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e . <br /> City of Orono <br /> � Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: <br /> �g,O j� PO Box 66 — / <br /> �O „ O Crystal Bay, MN 55323-0066 Date received: � �'�ZD —1 <br /> � , � <br /> '�'�' -- Received b <br /> �,a • -� ,, Street Address:' Y� <br /> '� : �� �,,`� 2750 Kelley Parkway �Q� � -pl aCl Plan review Fee: J�' � , �9 <br /> ��qg.� 'og� Orono,MN 55356 —�f-- <br /> �.�ex, <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 retumed. (Please prini) <br /> GENERAL INFORMATION: <br /> Job Site Address: �3�.� l��P�.a�a`� C�o v�2 �-u . L 0 ��^�, ►'�.) <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> lI yes,a special event permit is required wifh Police Department and Gty Council approva160 days prior to the event. 5hutde bus service will be <br /> ,requlred unless applica�rt demonstrates sufficient on-site parking is available. Non-permitted events will noi be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �01��--a�c1 ,�-.�S <br /> State License# Expiration Date: <br /> Phone: q s�. - �I�3 �a.o office � io i d--�s►-q�S� (cell) <br /> Mailing Address: ' �� W�, 2�.�G �„ ��=,s� Cit : W�, z:_„�•, ZIP: s�3� I <br /> Contact Person: Vv��r�� .�J; \ ;�-� S Applicant is: ontractor / � Homeowner (GrcleOne) <br /> Emai!and/or Fax: w�c���',�\;.�,,,.,5��,,,�,�,S �a y�,y�c%o • �c�vv� <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): " <br /> Address: Cit : ZIP; <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMA710N: <br /> Name: <br /> Phone(day): � <br /> Address: City: ZIp: <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 ,�X]Residence <br /> Addition attached garage ❑Garage/Acoessory 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 /> ❑Publlc ❑Storage [�(Public Water <br /> "Any earth movement may require ❑Commercial ❑Other(specify) <br /> MCWD review�permits. ❑Industrial <br /> Minnehaha Creek Watershed Oistrict(MCWD) ❑Other:(specify) — - ❑ PriVete Well <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952�71-0590 <br /> Fax: 952�d71-0682 <br /> www.minneh h cr ek_or <br /> Estimated Construction Vatuation(excluding land) $ 3 � , ro G • ° <br /> --r--- <br />