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, ( ��3�� _ �-� <br /> � ���,� �y5 <br /> Cit of Orono ���� <br /> Y <br /> Building Permit Application �� <br /> for New Structures or Additions �`���� <br /> Mailing Address: a0 ��_�/�J!-" <br /> �,0,�. PO Box 66 <br /> Permit number: <br /> Q � Crystal Bay, MN 55323-0066 Date received: // �..`f <br /> ����'� Received by: <br /> .� �����_�,;�, a. Street Address:� <br /> �'�t ? ��:�'�,� �� 2750 Kelley Parkway Plan review fee: / �. ��9 <br /> '�gESHog� Orono, MN 55356 a D !�— / ,sS <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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ' "`� O �,�'�ti�}�j� V�, <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 approva160 days prior to the event. Shuttle bus service iff be <br /> required unless appficant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/A �LICANT INFOR,JVIATION: . <br /> Name: � � �. , <br /> State License# , Expiration Date: <br /> Phone: ` � � office . 3 cell <br /> Mailing Address: 3�6 - c� Cit � � ^ � ZIP: �r' <br /> Contact Person: Applicant is: ' Contractor / Homeowner (Cir�le One) <br /> Email and/or Fax: � � G c- 6� ' <br /> PROPERTY OWNER INFORMATIO : � <br /> Name: ` 0 <br /> Phone (day): �, <br /> , , .�- <br /> Address: Cit ` ZIP:��_ <br /> Email and/or Fax �- °� <br /> ARCHITECT/ ENGINEER INFOR A�T ION: I <br /> Name: �_4-�-�IC � �Y����� �o " L� � ����, � ���1���— <br /> Phone (day): � :C <br /> Address: � Cit :. � -� ' ZIP:�� <br /> Email and/or Fax: _� �� ti, <br /> � <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 �2esidence <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) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "*Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review 8� 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.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />