Laserfiche WebLink
�'o� 30 �� <br />. ��-21 <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions �ao. so � <br /> Mailing Address: I Permit number. �O0 "����8 � <br /> ���� PO Box 66 <br /> Q\ Crystal Bay, MN 55323-0066 Date received: ��'—��0�� � <br /> � ��� 1 <br /> a �` ^�,�;;�. a, � Street Address:' Received by: �� <br /> �',�c, '� Gti 2750 Keiley Parkway Plan review fee: 7�•7 0 <br /> r`�gESHo�''� Orono, MN 55356 � _QO 7/-� <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: � � - 'i� � /`�� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or o her Display Home? ❑ Yes ��o <br /> If yes, a special event permit is required with Police Departm�j1t and Cify Counci!approva/60 days prior to the event. Shuttle bus servrce wil!be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events wifl not be allowed. <br /> CONTRACTOR!APPLICANT INFORMATION: _ <br /> Name: �� �. ` � � '`�. <br /> State License# C- � Expiration Date: <br /> Phone: �G—� (office cell) — <br /> Mailing Address: ,� , � ; Cit : ZIP: �: �—c-` <br /> Contact Person: : �,� � � �. % Applicant is:C�ontra tor�� Homeowner (CircleOne) <br /> Email and/or Fax: � � --- <br /> PROPERTY OWNER INFORMATION: <br /> Name: �C� v �C_%�.�� <br /> Phone (day): <br /> Address: _ �� � � � ;�� ��� ��, City:�j���j��; ZIP: ���� <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1. Type of Project I 2. Pr posed Use 3. Structure Type 4. Sewage Disposat & <br /> Water Supply <br /> ❑ New Construction Single Family with ❑ Residence <br /> ❑ Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑ Acce sory Building ❑ Single Family with ❑ Deck <br /> ❑ ocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ S rage ❑ Public Water <br /> '`'`Any earth movement may require ❑ Commercial Other(specify) <br /> MCWD review& permits. ❑ Industria� � oi���'Lp� ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) t� <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-A71-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) � �,� �'� <br /> Last Updated: 6/2212009 <br /> - 19 - <br /> . l ., ... .... ._:.,�W �..:.._ _� . . _ .. . .....:� <br />