Laserfiche WebLink
y � � <br /> � � <br /> City of Orono <br /> Building Permit Appiication <br /> for New Structures or Additions <br /> MailiPO Bo�r66 . Permit number: a �-�� �j9 <br /> ��� <br /> � � Q Crystal Bay, MN 55323-0066 Date received: q f� <br /> � �c <br /> `-�s�.?> �. Street Add�ess:� Received by: <br /> ��r9, ` ����� 2750 Kelley Parkway Plan review fee: <br /> kESH��' Orono, MN 55356 <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: � -7 ,� � C � ,- " � v p ��Z� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes, a specia/event permit rs required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless appfrcant demonstrates sufficient on-sife parking rs available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPL CANT INFORMATION: <br /> Name: �CL�1� ��=� <br /> State License # Expiration Date: <br /> Phone: LP/o2 - Srj� .- ,$'�.. g office cell <br /> Mailing Address: � G /Z/C Cit : �l//y@ `' �-^ / <br /> Contact Person: Applicant is: Contractor / Ill@OWfI. (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER I FORMATION: <br /> Name: iC -1csC % /-�/L�/�,: <br /> Phone (day): �'�'� - r - �ZD <br /> Address: 3�f7 L � /C 1�g Cit : �4/1�f2R� ZIP: �S3�1'r <br /> Email and/or Fax <br /> ARCHfTECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> ° Address: �it . Z�P� <br /> - Email and/or Fax: <br /> � PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> 5��� 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 ara e <br /> ❑ Other: (specify) 9 g ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Multiple 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: (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) $ �Qj�i� c�.o_ <br /> Last Updated: 9/29/2009 <br /> - 17- <br />