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� <br /> ' � I �` � 7� <br /> �u� 5�`� city of orono g � 3(� � <br /> � <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: b��- �J� <br /> ���►„�,�. PO Box 66 <br /> ,, \ Crystal Bay, MN 55323-0066 Date received: � '�� ( I <br /> �I X�s�� I Received by: � <br /> `'„� � 1,�,� ` ,,�, Street Address:� <br /> �\���'�,����� Gti 2750 Kelley Parkway Plan review fee� �� , g�� ��� L��� <br /> l ���'�� � Orono, MN 55356 <br /> qhESH�4 <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: �j'��� � , � �1 �V"l/ (�"r�tJU <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> /f yes,a special event permit is required with Police Department and Ciry Council approva/60 days prior to the event. Shuttle bus service i/l be <br /> required un/ess applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: � �f �/O <br /> State License# ' Expiration Date: <br /> Phone: - ' •Z- � office cell <br /> Mailing Address: `(�5(� � fl - , Cit 7'I�Q(� ZIP: <br /> Contact Person: �� ���J�- Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: ,,���N��--L C�D�wi�,>G-i����l,,r�/�/l <br /> PROPERTY OWNER INFORMATION: <br /> Name: I,/l�(G- �..X� SUC }-i(�/�LUN�-�- <br /> Phone (daY): �i�i2 -221 � ��Z4� <br /> Address: Cit : ZIP: <br /> Email and/or Fax (+✓1���-� e ()��1�' C N�V1 A/� • (O�V� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ��'� � CCf�1��[�=-� <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 �0 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&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) $ ��U <br />