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- City of Orono <br /> Building Perr�it Application <br /> for New Structures or Additions <br /> � Mailing Address: �pErm�t�umber, �f ��,„� <br /> �,0 j�. PO Box 66 �, , <br /> f,: <br /> r Q 4 0 Crystal Bay, I�N 55323-0066 Date receiued '''7' `����� <br /> ��-+�.,�•. _ -� <br /> ,,a °;. a, Street Address:' Re�1Y8��-� � <br /> � '� � �, �ti�' 2750 Kelley Parkway Paan arevie�rfee. � �•� 4 <br /> �•7 e':. r <br /> \'�g�Ho4� Orono, MN 55356 ` <br /> `_—� �,: 4�1.��''�'-�-�.�,�`a�. <br /> Tfltak�ee: - <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � t,. '- �` 'E ° - ;„; , <br /> : . , <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � <br /> Will this be a Parade of Homes, Remode s Showcase Home or other Display Home? ❑ Yes �No <br /> If yes,a special event permit is required with Police Department and City Councif approval 60 days prior to the event. Shuttle bus service will e <br /> required unless applicant demonstrates sufficient on-site parking is avaifable. Non permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMAI�'iION: , <br /> Name: e T�'U c <br /> State License# _ 3��5 Expiration Date: - ° <br /> Phone: 5 ^- 33 ^ 30 o ice �^ ,3�-,� cell <br /> Mailing Address: 3 Cit : c� - ZIP: <br /> Contact Person: ` i`�" App(icant is: ontraetor / Homeowner (Circle One) <br /> Email andlor Fax: ' c � 3 -3a�� <br /> PROPERTY OWNER INFORMATION: r \ I - <br /> Name: ��:��Q.S -� `��t�.,/�_ ��n l 1'h. <br /> Phone(day): .� -� �jl �f <br /> Address: � ^ Cit : ZIP: ���y <br /> Email and/or Fax 'yl G ,�-� <br /> ARCHITECT/ENGINEER INFORMATION: ,�,��`yG��n � �.�5'(3c <br /> <,. /��, <br /> Name: �Uo� �l AAL�IA � ' �T � , <br /> Phone(day): — p����� '� <br /> Address: j^ Cit : � ZIP:�� 3 <br /> Email and/or Fax: �x 7�3 7���5� <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 '��esidence <br /> �ddition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> LJ Accessory Building ,� Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑Office/Commercial ❑ Private Sewer <br /> ❑Other:(specify) ❑ Muftiple Family/Condo ❑Warehouse <br /> � Pubfic ❑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.m inneha hacreek.or <br /> Estimated Construction Valuation (excluding land) $ �J�, �j�, <br />