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, <br /> / � . <br /> , - . City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: permit number: � l�'rj � <br /> QA,. PO Box 66 <br /> � `V� Crystal Bay, MN 55323-0066 Date received: <br /> StreetAddress:' ceived by: <br /> y ,� 2750 Kelley Parkway review fee: '2 . g� <br /> �' �� Orono, MN 55356 t <br /> t�'�fSHO��' Main: 952-249-4600 To al Fee: <br /> 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: (� � � (� <br /> Will this be a Parade of Homes, Remodelers Showcase Ho e or other Display Home? ❑ Yes No <br /> lf yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service "ill <br /> required unless applicant demonstrates su{ficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP CA T NF MATION: <br /> Name: � � v�?n �, <br /> State License# Q / Expi�tio Date: — <br /> Phone: cell - office � - <br /> Mailing Address: ' Cit : ZI : <br /> Contact Person: Applicant is: ontracto / Homeowner (Circle One) <br /> Email and/or Fax: �r��� � ��� �� � � ���„� <br /> PROPERTY OWNER NFOR TION: <br /> Name: Q � <br /> Phone (day): - <br /> Address: Cit : � ZIP���� <br /> Email and/or Fax � <br /> ARCHITECT I ENGINEER,INFORMATION: , , <br /> Name: � ` <br /> Phone (day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax: ,. <br /> PROJECT INFORMATION: Description of project: � �� �' � �� <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage isposal 8� <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with Accessory Bldg./Garage <br /> ❑Addition attached garage ck ❑ Public Sewer <br /> Accessory Building �Single Family with ❑ Office/Commercial <br /> elocation detached garage ❑ Residence <br /> ❑ Private Sewer <br /> ❑ Other:(specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> '*Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review& permits. ❑ Industrial ❑Warehouse <br /> ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other:(Specify) ❑ Other(SpeCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ l�,�j, ���-�" <br /> �-- <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />