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r ' <br /> . ^ <br /> . �J� �� <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Maifing Address: Permit number: O/�- 00 7 <br /> �,L,0,� PO Box 66 <br /> Q , �\ Crystal Bay, MN 55323-0066 Date received: � /O <br /> la �4�'��:��^1� 1 <br /> ��:4,:;`;� �,j� StreetAddress:' Received by: <br /> ��� '����� �� 2750 Kelley Parkway Plan review f : <br /> L � ��,�' Gti <br /> 9'kESH�g'� Orono, MN 55356 , <br /> Total Fee: � `Za ,?j(p <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: `�j5 1lo L.�,��� ��� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �c] No <br /> !f yes, a specia/event permit rs required with Police Department and City Councrl approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permrtted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circte One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: 'Er�k �r��,e„� <br /> Phone (day): ta 1� Sa� - o��� <br /> Address: 3S�i� ►-�Q,� �,� City: p�c�v�� ZIP� SS 35 � <br /> Email and/or Fax _ �r, C�1tie,,� ��,;� �o�-,•ti.�;\_ ;,,,,� <br /> � <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: Z�P� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� <br /> ❑ New Construction Water Supply <br /> ❑ Single Family with ❑ Residence <br /> ❑ Addition attached garage ❑ Gara e/Accesso Bld <br /> ❑ Accesso Buildin 9 rY 9• ❑ Public Sewer <br /> ry g ❑ Single Family with � Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> [� Other: (specify) '�C.� ❑ Multiple Famity/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) $ ` , 0 <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />