Laserfiche WebLink
� � � <br /> � <br /> , ,� City of Orono � � <br /> (�!l�� �uildin Permit A lication � � � <br /> J p p ��, -��.s <br /> for New Structures or Additions <br /> --- Mailing Address: Permit number: � � (�' �� <br /> � PO Box 66 <br /> '�� �����. <br /> i0 , Q'��,, Crystal Bay, MN 55323-0066 Date received: � — �—� <br /> �1��a �^yS4�✓.J��:,_ �,��� Sfreet Address:� Received by: � <br /> ���,�e, ,�}���;�,�ty'�� ��,� 2750 Kelley Parkway Plan review fee: �Ca� .�j <br /> \"t`�g�sHOSa.�,�> Orono, MN 55356 <br /> -=—_- Total Fee: �Ofc�-��yD7-- <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us 4 -LOIL-0010 <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 /> GENERQL INFORMATION: <br /> Job Site Address: � ,� � � - ,�,�j ��' ` ,� ' ti ,c J`�'1 IL j 5�� i <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Displa Home? ❑ Yes �No <br /> !f 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/qP�PLICANT INFORMATION: <br /> Name: 41G (�c �- C�;r�,r��- �� ��C�(���' <br /> State License# , Expiration Date: <br /> Phone: �� - �( ��- (�S�,� (office) (cell) <br /> Mailing Address: LC.,. � C,,,; }� � Cit : .} ` ZIP: �� � �' <br /> Contact Person: /�.i C��mc� �c_4�r�.c�n; Applicant is: Contractor / Homeowne (circ�e o�e) <br /> Email and/or Fax: ;����, r n-.«,: �,�_},r.c�n r h� � �� r� �=� i ��--.�n s��-�.� ..C�- ,v� <br /> PROPERTY OWNE�t INFORMATtON: � <br /> Name: ��� � c� � l\)p f rv��� S�hr�^r;" <br /> Phone(daY)� y��� .�/;,}� - (��3S �t'Uc,;�c_- wc . �;� <br /> Address: i 'l.�c�' Lc. k �- �; ���,�� tA- J e City: �,U(1:�?_c-t�-� ZIP: �J 5�3 r) <br /> Email and/or Fax y��, ��r•�a 6 S r (-�n��� �� �er,� r� i�,�.� �n�-!-;. c c�r�--� <br /> ._ <br /> ARCHITECT/ ENGIPIEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: 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 /> [v]'Addition attached garage �"Garage/Accessory Bldg. [�"Public Sewer <br /> ❑Accessory Building ❑ 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 [YPrivate 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.minnehahacreek.or <br /> Estimated Construction Valuation(excluding land) $ � (1 O�"i(i <br />