Laserfiche WebLink
City of Orono <br /> Builcling Permit Application <br /> � for IVew Structures or Additions <br /> , Mailing Address: <br /> PO Box 66 Pe�it number. ��,-�(�` <br /> ��O Crystal Bay,MN 55323-0066 Date received: <br /> StreetAddress:' Received by: <br /> y 2750 Kelley Pa ` � J <br /> �' ��� Orono,MN 55356 Z� ^ P�an review fee: �� � 7 �� <br /> �kFsxo�`�` Main: 952-249-4600 �~� 1 ----- <br /> Fax; 952-249-4616 www.ci.orono.mn.us Total Fee: <br /> Thls ap�ication#orm must be c�arr�pteted in futf artd'a!��uired in#ormation must be su6mitted. <br /> InCompfete appli�tions w#il he r�um+�cf. (P/ease prinf) <br /> GENERAL INFORMATION: <br /> Job Site Address: � <br /> Will this be a Parade of omes, Remodele howcase Hom or other Display Home? Yes No <br /> K yes,a specla/event permit fs risqufred w/th Police Deparfinent and C/ty Cound/appmval 60 days prior to the event. Shutt/e bus service will be <br /> requ/red unless appHcanf demonsbafes sul�cfent on�lte parking/s avallab/e. Non pem►itted events wdl not be albwed. <br /> CONTRACTOR/AP � ANT INFORMATION: <br /> Name: ��1 S Zr�L - <br /> State License# Expiration Date: . 3 � r� <br /> Phone: cell . ( o�� 3 , ` <br /> Mailing Address: 1 p p ' �c � � C' : Z�p: <br /> Contact Person: Applicant is: n a / Homeowner (Circle One) <br /> Email and/or Fax: • � <br /> PROPERTY OWNER 1 FO MATION: <br /> Name: �,-� 0.� <br /> Phane(day): - �-- 1.� s t <br /> Address: o o.. C� : �S ZiP: ���2� <br /> Email and/or Fax � , � <br /> ARCHITECT/ENGIN ER INFO ATIO • <br /> Name: ' � ' <br /> Phone(day): -a O - � . � <br /> Address: ` C' ZIP: ) <br /> Email and/or Fax: � `� � �p <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: C� : Z�P <br /> Email and/or Fax: <br /> PROJECT INFORIVIATION: Descri tion of ro ect: � �' � �-(c;>l'�^�Z.. <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8 <br /> �New Construction 1Nater Supply <br /> Addition �Single Family with ❑Agcessory Bldg./Garage <br /> attached garage ❑ Deck <br /> ❑Accessory Building � ❑ Single Family with ❑ Office/Commercial �0 Public Sewer <br /> ❑Relocation detached garage ❑ Residence <br /> ❑Other.(specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) (Cosmpiiance csrtificate <br /> ❑ Public 4-feet or greater may be required) <br /> *"Any earth movement may require ❑Commercial ❑ Storage <br /> MCWD review�permits. ❑ Industrial ❑Warehouse ❑pubiic Water <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other:(specify) ❑ Other(specify) <br /> 15320 Minnetonka Bivd;Minnetonka,MN 55345 <br /> Phone: 952-471-0590 / Fax: 952-471-0682 ❑ Private Well <br /> www.mirmehahacxeek.ora <br /> Estimated Construction Valuation(excluding land) $ � <br /> Packet Last Updated: January 2016 <br /> Paae 29 <br />