Laserfiche WebLink
. � � � ' , � _ _ <br /> � �SC,R�I' �.d Q Z I I <br /> � il <br /> C ty of Orono � 1 <br /> Building Permit Appiication <br /> for New Structures or Additions <br /> Mailing Address: Permit number. �l!�0 /� <br /> Og.�,�.0 PO Box 66 <br /> Crystal Bay,MN 55323-0066 Date�eceived: // <br /> � � StreetAddress:' Received by: <br /> 2750 lGelley Parkway Plan review fee: � 7',5, p `''l <br /> '��o�.�G Orono,MN 55356 ���_ ��� <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This appiication form must be completed in full and all required information must be submitted. <br /> Incompiete applications wiil be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: Z'�� �K��P �F VJ C(�L� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> n y�s�e�e��pe�►►►�r Es►�ur►ed w�►��e►ane►a ar,d chy co�ndi e�►o�er so days p►►or to n,e e�r. sn�rws�w;�i ae <br /> requlred unbss app/kant demonsbstea suA4cient a►-sA�a parkTip!s aveFkble. Non pem►ilMd events wiM n�be allow�xi. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: L �IL�D rl� <br /> State License# 3 Expiration Date: <br /> Phone: _ 22\-2 office cell <br /> Mailing Address: 360 G l C' : ZIP: <br /> Corrtact Person: Applicarrt is: on actor / Homeowner �c�.u.ons� <br /> Emai)and/or Fax: � � C� <br /> PROPERTY OWNER I�ORMATION: <br /> Name: �M �I�1� <br /> Phone(day): �_ --1 2 <br /> Address: 3�� Y 1 W C I �.LE C' : b NV ziP: �5 3 5Co <br /> Email and/or Fax t' n 2 'c.e <br /> ARCHITECT/ENGINEER INFORMATION: t�`O^'�ass r y a�Q c�WG�td��� a�l e'� <br /> Name: �TS,D OFSTl�U�l <br /> Phone(day): '? 3- 2 - 7 <br /> Address: 3� S C' : ��N��ZIP: �S <br /> Email ancUor Fax: co S � <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.3tructur+e Type 4.Sewags D(sposal8� <br /> Water Supply <br /> ❑New Constru�tion ,�Single Family with ❑Residence <br /> ❑Addition attached garage �Ga►age/Accessory Bldg. ❑Public Sewer <br /> �Accessory Building ❑ Single Family with ❑Dedc <br /> ❑Relocation detached garage ❑Office/Commeraal �Private Sewer <br /> ❑Other:(speafy) ❑MuRiple Family J Condo ❑Warehouse <br /> ❑Public ❑Storage ❑Public Water <br /> '"Any eartl�movement may require ❑Commercial ❑Other(speafy) <br /> MCWD review&permits. ❑Industria� '�,Private Well <br /> Minnehaha Creek Waterahed D�trict(MCWD) ❑Other.(specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952�471-0682 <br /> 'n <br /> Estimated Construction Valuation(excluding land) ; <br /> �st u�a: a�zsrzot� <br /> -19- �� �` <br /> <�� ' <br /> � �J <br />