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,, <br /> _ - �y� � <br /> - � �f 1 <br /> City of Orono �-�' � �� <br /> Building Permit Application � <br /> for New Structures or Additions G�` <br /> Mailing Address: Permit number: f�� Q - � cf cJ <br /> �v 0,� PO Box 66 { <br /> � �:. � , <br /> Crystal Bay, MN 55323-0066 Date received: � � � � D <br /> a I�;'�`� � Received by: <br /> ����,;;, �,� StreetAddress:' <br /> �'�,n � � �,'�_'up_ � 2750 Kelley Parkway Plan revie — -- <br /> t "� ���r G Orono, MN 55356 <br /> 9kESH0�� <br /> otal Fee: � q G} <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � � �/' �J <br /> This application form must be completed in full and all required info ation m hm_itted. <br /> Incomplete applications will be returned. (Pleas � t <br /> GENERAL INFORMATION: --- --- <br /> Job Site Address: �'� ���_'1 -- ��.t���,��.y �� j� ��). <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No <br /> If yes, a speciaf event permit is required with Police Department and City Council approva!60 days prior to the event. Shuttle bus service wilTbe <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: � <br /> Name: _ �e- f-.t — r-� � ,;• i �,.;. <br /> Phone (day): - ��;� -� ,- <br /> < <br /> Address <' ',n��, i a Cit ��- i. ZIP: � <br /> Email and/or Fax �C -{( , r „ � �. <br /> ARCHITECT/ ENG ER INFORMATION: <br /> Name: t._.�_�� ., i. <br /> r- ��- ,� <br /> Phone (day): � _ �k _ _ � , ) <br /> Address: ' �� ~—�^i f,lcn'�' � +�) ti�'!.����_ City: _ '�",p 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 r <'"' . detached garage ❑ Office/Commercial ❑ Private Sewer <br /> �Other (specify) ��,t- %� ��t���r�(� ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "`*Any earth movement may require ❑ Commercial �Other(specify) <br /> MCWD review& permits. ❑ Industrial �,. ("'4 t`���za) ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) 1�"�� <br /> 18202 Minnetonka Blvd S_._�}'�� <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ '�=..,��' ��j'*; <br /> Last Updated: 9/29/2009 �� � <br /> - 17 - <br />