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� } <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: b��- �J� <br /> ���j,0,�. PO Box 66 <br /> ,s, \ Crystal Bay, MN 55323-0066 Date received: � �� ( 1 <br /> �� �,:, <br /> s�� , � • Received b /� <br /> I`a �y �t�,� „_ a, Sfreet Address: y� <br /> �\ ���,�t� �ti 2750 Kelley Parkway Plan review fee� Q� , g� �� 2��,� <br /> rqkE8H04� Orono, MN 55356 <br /> \`''____: <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 returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ?7�j�,—rj � (�,t/ �'�jFJp <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 Cify Councrl approval 60 days prior to the event. Shuttle bus service ill be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not 6e allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: � �f �/O <br /> State License# Expiration Date: <br /> Phone: - -�— � office cell <br /> Mailing Address: `(�Cj(� ," , Cit •('/}�l(� ZIP: <br /> Contact Person: � ����-�-- Applicant is: ontractor / Homeowner (Cirde One) <br /> Email and/or Fax: ,���fJ;� L C�Q,C.�%����i��l,d/�✓1 <br /> PROPERTY OWNER INFORMATION: <br /> Name: R/1P'�(G- �� SUC }-I(:�/ry(JN�� <br /> Phone(day): �Z -�Z21 — 43 Z F� <br /> Address: Cit : ZIP: <br /> Email and/or Fax jl�Ip�Jt�� � urJ�- � j�M �(/1 . (,Dil/� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �.�"� � C-CI�(1���7Cj�"=-.� <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& <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 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: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �C"�O <br />