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�.. <br /> r <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: �'� <br /> g�,�. PO Box 66 Permit number: �D f `"�d� f C� �;s�C <br /> � � Q Crystal Bay, MN 55323-0066 Date received: /� �v fG� f �� � <br /> a T��� a, StreetAddress:' Received by: �� � , ��.L�F/ <br /> �2, �� '� �ti`� 2750 Kelley Parkway �l Z "'] �� �5 <br /> '�9g�Hog,� Orono,MN 55356 ��` �a'Sa� Plan review fee: <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. (P/ease print) <br /> GENERAL INFORMATION: �5 5 ma.�Ki r�✓�� �."�. � ° <br /> Job Site Address: —3 ���a � b� <br /> Will this be a Parade of omes, emodelers howcas Home or other Display Home? Yes No �-�^$� <br /> /f yes,a special event permit is required with Police Department and City Counci/approval 60 days prior to the evenk Shuttle bus service wi/l be <br /> required unless applicant demonstrates s�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INF�RM�ATI�N:� � <br /> Name: <br /> State License# Expirat'on Date: — <br /> Phone: Q � — office V � � — ��g� cell <br /> Mailing Address: �' � 0 Cit : 1l��/\, ZIP: <br /> Contact Person: ,/�,/� � ,1� �pp icant is: Contrac or / Homeowner �c�:oie ooe► <br /> Email and/or Fax: G CAI�. 1' ,A E� �tA � d1 C S. <br /> Name:ERTYOWNERINFO�M�ION:�i„� � _��t� � �i��� �•" <br /> 1 <br /> Phone(day): . � /� <br /> Address: 30?�.a. 0 �.�.4� Cit : ZIP:�'J�J'�3StiP <br /> Email and/or Fax (` <br /> ARCHITECT/ENGINEER I FORM TIO � <br /> Name: �~1V C�J�u <br /> Phone(day): � • .L <br /> Address: 1 � ST c�c :�i11M��'o�A�C ziP:553 05 <br /> Email and/or Fax: Z i r cc . C.d <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 J�,Residence <br /> ❑Addition attached garage ❑Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Buitding ❑ Single Family with ❑ Deck <br /> ❑ Relocation 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) ❑Other:(specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � — <br />