Laserfiche WebLink
City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: �„ � J7 7 <br /> /��,�. PO Box 66 Permit number: <br /> /� � Crystal Bay, MN 55323-0066 Date received: �` � <br /> �j��,a �"'�"�t�-.= a,�, StreetAddress:' Received by: <br /> ��',�, � ��;;� �ti� 2750 Kelley Parkway Plan review fee: <br /> �t��Es`�og� Orono, MN 55356 <br /> \., / <br /> _'---' Total Fee: a �, �� <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 app(ications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � ��?j� L,������ ��� <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 approval 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 will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: {�f� N v��y� �I O Q�'f�-12�5 <br /> State License# Expiration Date: <br /> Phone: �`_�-�p�(p ��ly�� (office) ,Z-��(�-yyy 7 (cell) <br /> Mailing Address: 5 S� Cit : ;,o,r- 1�- ZIP: � -� <br /> Contact Person: o r� q� AppIICBtIt iS:���n`trarfnr � Homeowner (CirdeOne) <br /> Email and/or Fax: Q S�-4?7S e;, - 5T�'�5� <br /> PROPERTY OWNER INFORMATION: <br /> Name: (_O(L� �Cj��-�2.�4�2 D,� <br /> Phone(day): —(� ,a, - l�-Zp- �{Z-Zg e <br /> Address: ���,5- t,v��-�r�ow✓� �Q City:(��rp�(� ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction �.$ingle Family with f�Residence <br /> ❑ 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) oo� �(�"��,� ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> `"'Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review 8 permits. ❑ Industrial <br /> ❑ 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.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 7,��(,� --� <br /> � yQ�--r�.+D U t= <br /> �t spl�+ ��n e Ip af l� t ri� �`1-w c� <br /> � N�W I�-t�-C�iPr� C'G,1� ►n-e'�fS i <br />