Laserfiche WebLink
' City of Orono <br /> Building Permit Application <br /> • � for New Structures or Additions <br /> Mailing Address: Permit number. � �,S— �j <br /> �A, PO Box 66 <br /> � `v� Crystal Bay, MN 55323-0066 Date received: <br /> StreetAddress:' � /� <br /> y ,�- 2750 Kelley Parkway , � 35 <br /> �' �` Orono, MN 55356 ����r�'�'QS( Plan review fee: � <br /> tqkFSH�4� Main: 952-249-4600 Total Fee: <br /> 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: j `(� � ��-�-y �r-.L j,.a v�� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes (r�No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: (�s-Q v�y�a� �}{o vv�� S <br /> State License # ;Z 5"J Expiration Date: <br /> Phone: cell � - -- �(� office <br /> Mailing Address: (o � p ov� M e w� Cit : � �+� �/ IP: SS '�.. 2 <br /> Contact Person: v� Applicant is: ractor / Home wner (Circle One) <br /> Email and/or Fax: � o c� ow�e s , �d+�'K <br /> PROPERTY OWNER INFORMATION: �/ <br /> Name: �-o j�l/�'�1 Rp�es <br /> Phone (day): <br /> Address: City: 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: Description of project: ��J �C��� <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal � <br /> Water Supply <br /> ew Construction ingle Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ O /Commercial <br /> ❑ Relocation detached garage esidence Private Sewer <br /> ❑ Other:(specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater [ ik lic Water <br /> **Any earth movement may require ❑ Commercial ❑Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) ❑ Other(speCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ J`�f�v� aB (� <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />