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- � . <br /> �''v <br /> City of Orono ��� <br /> . . . . . � �D�h <br /> Build�ng Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number. ��d—� <br /> O��,j�.O PO Box 66 <br /> Crystal Bay,MN 55323-0066 Date received: _ /D <br /> Street A�iess:' Received by: /�•O• — <br /> � �ti`� 2750 Kelley ParkwaY Plan review fee: <br /> ��ag,� Orono, MN 55356 <br /> Total Fee: ���� <br /> Main: 952-249�600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required inforrnation must be submitted. <br /> Incomplete applicatlons will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: (�t5 �- ���- �e CSro+w M1� 55314 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> If yes,a special ev�t permit is required with Police Department and City Council approval 60 days prio�to the event Shuttle bus seivice will be <br /> required uNess applicant demonstretes suficient ar-site perking is aveilable. Non p�mitted events will not be allowed. <br /> CONTRACTOR 1 APPLICANT INFORMATION: <br /> Name: a4n�no� �o�p;o <br /> State License# Expiration Date: <br /> Phone: office �o�a-51�-a5� cell <br /> Mailing Address: la15 �; /��� Cit :Ocbro ZIP: 553 1 <br /> Contact Person: M; e R, e Applicant is: Contractor / om �ci�ae o�.� <br /> Email and/or Fau: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �nna. '�Oto <br /> Phone(day}: - (00 (� <br /> Address: (015^ i„yr;c ��� City: �Cor�o ZIP:'�'��J 3 I I <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8 <br /> Water Supply <br /> ❑ New Construction ❑Single Family with ❑ Residenoe <br /> ❑Addition attached garage ❑Garage 1 Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with �Deck <br /> ❑ Relocation �� � D�� detached garage ❑Office/Commercial ❑ Private Sevwer <br /> �Other:(specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑Storage ❑Public Water <br /> "'Any earth movemerrt may require ❑Commercial ❑Other(specify) <br /> MCWD r�eview 8 permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed DisVict(MCWD) ❑Other:(SpeCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> Estimated Construction Valuation(excluding land) $ �OD,— r1/� f!• � <br /> Last Updated: 9/29/2009 <br /> - 17- <br />