Laserfiche WebLink
I. , . <br /> City of Orono <br /> Building Permit Appiicati <br /> � ��a�� <br /> for New Structures or Additions <br /> Mailing Address: Permit number: Gt����-bf oz�7 <br /> /O.�D,�.O PO Box 66 IL <br /> Crystal Bay, MN 55323-0066 Date received: Z—7�� <br /> ���"*'�� Received by: � <br /> ,a '��� ` �, � StreetAddress:' <br /> '�, ' �.��;,�j„ ���' 2750 Kelley Parkway Plan review fee: .7d <br /> \lR���`og*Y Orono, MN 55356 aG/�—U/ �/ <br /> \:,Esx,� � <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: ��"S—��C e��j � � �� � . <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 City Council approva160 days prior to the event. Shuttle bus service will b <br /> required unless appficant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMA I N: � ' � <br /> Name: `����'t v dJ�V� a C t� ���' �! � �- <br /> State License# Expiratio Date: <br /> Phone: � - - office (cell <br /> Mailing Address: 22. I fzV' Ov Cit : +V : "S"S <br /> Contact Person: AppJicant is: Contractor / omeow r (Circle One) <br /> Email and/or F�c!--� � 01li1l� ° y C i2Q �C � F��'}-�Qlz . (c� <br /> T <br /> PROPERTY OWNER INFOR�M fTJON: �� <br /> Name: - '�' <br /> Phone (day): 2- - - ;�n <br /> Address: �" f' i Cit : l�t��i/� ZIP: ��3 <br /> Email and/or Fax ` —�c F -(- �i . c� <br /> ARCNITECT/ENGINEER �O�R�MATIO O�� �a C��� ��S'��� <br /> Name: <br /> Phone (day): - �� ��d,�� <br /> Address: 2 4' �✓ Cit : ZIP: ����� <br /> Email and!or Fax: j : �� t, ,d C + ✓ � <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑ Residence <br /> ❑Addition attached garage �arage/Accessory Bldg. ❑ Public Sewer <br /> �Accessory Building ❑ Single Family with ❑ eck <br /> elocation 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) �O r SpeCify) A,��..i.,�p <br /> 18202 Minnetonka Blvd �'� V � r K <br /> Deephaven, MN 55391 q �� ^f� \ <br /> Phone: 952-471-0590 v'�/¢� q ' `� v C���� <br /> Fax: 952-471-0682 �--{��f� � <br /> www.minnehahacreek.or � ��� <br /> Estimated Construction Valuation (excluding land) $ �i �� <br />