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; � � � �g� <br /> . , ���/,� � <br /> l <br /> C� <br /> . �� ,� N� <br /> �� � - �s <br /> City of Orono �, D5`� <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: permit number: O7�! ' ���� <br /> Q PO Box 66 ' I <br /> � �Q Crystal Bay,MN 55323-0066 Date received: .L'S" �`-f <br /> StreetAddress:' Received by: U�U <br /> y� ,� 2750 Kelley Parkway Plan review fee: /J� � 3 <br /> �c,` Orono,MN 55356 dp� ��D//l <br /> ��kesHo� Main: 952-259-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us � I� <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 INFORMATIO�: � <br /> Job Site Address: ���;5 �..����� � ���� _ �.� <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 Po/ice Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required un/ess applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFOR �TION: <br /> Name: i c31� <br /> State License# Expiration Date: , <br /> Phone: cell � � office <br /> Mailing Address: " � Cit : , ,,� ZIP: �'� � <br /> Contact Person: ,. Applicant is: ntrastoC, / Homeowner (Circle One) <br /> Email and/or Fax: � <br /> PROPERTY OWNE I FORMATION: <br /> Name: � �,�,� � ,� � <br /> Phone(day): � <br /> Address: � ��ty:�r6�Ka�n pGr'�: 5� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2.Proposed Use 3. Structure Type 4.Sewage Disposal 8 <br /> Water Supply <br /> �] New Construction �Single Family with �Residence � <br /> �[]i��ddition '`attached garage ���arage/Accessory Bldg. 14J 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 8�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�71-0682 <br /> www.m i n n eh a h a cre e k.o r <br /> Estimated Construction Valuation (excluding land) � �o2.5f �UZ% <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />