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� ; , . �,/O� <br /> �1 <br /> +� � � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: , �(�/�--d�3/ <br /> 4v�,� PO Box 66 �7 <br /> Q �\ Q` Crystal Bay, MN 55323-0066 Date received: .:� /�o /b <br /> ��'�`' Received b <br /> � �`�'�rt`°-��' s. StreetAddress:' Y� � • �• <br /> ��s�� <br /> �'� ��"�,� ��/ 2750 Kelley Parkway Plan review fee: <br /> L�kESH�4'� Orono, MN 55356 <br /> Total Fee: ��l, v� <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: ;�f S�,J a � <br /> Will this be a Parade of omes, Remodelers Showcase Home or oth Display H me? ❑ Yes �No <br /> If yes, a special event permit is required with Police Department and City Counci/approval 60 days prior to the event. Shuttle bus seivice wi// e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT IN�MATION: <br /> Name: Q 1�,� <br /> State License# �„/ (�7 3�L7 4�J/(, Expiration Date: o � <br /> Phone: p? _ _ office) (cell) <br /> Mailing Address: � y,a,� �-v� Cit : ZIP: <br /> Contact Person: � � Applicant is: Contrac r / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATI N: <br /> Na me: � ;�_ N.o�, `Gt,►� <br /> Phone (day): ���_ Z�� �j�T� <br /> Address: � Cit : ZIP: <br /> Email and/or Fax „ <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: _ N/,� <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 & <br /> Water Supply <br /> � New Construction ❑ Single Family with ❑ 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) ❑ Multipte 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: (s eCify) <br /> 18202 Minnetonka Blvd -� <br /> Deephaven, MN 55391 ' -�'�,�""' <br /> Phone: 952-471-0590 /�it c.{��P��..r�5� <br /> Fax: 952-471-0682 C <br /> www.minnehahacreek.or <br /> Estimated Construction�Valuation (excluding land) $ <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />