Laserfiche WebLink
r <br /> � , . � �l�� �5"�' <br /> � � s�c <br /> City of Orono �� <br /> Building Permit Application � / � C��� <br /> for New Structures or Additions <br /> �_—_,` Mailing Address: Permit number: d��a '�� �3� <br /> ��O�O Cry Bal Bay,MN 55323-0066 Date received: J�'Z� '�Z _ <br /> '�45; Received b ,u S <br /> � ����..�, y: <br /> � ^�;��,�- �, StreetAddress:' DO <br /> � �� ti 2750 Kelley Parkway Plan review fee: /DDD� P <br /> �t ,' ��� ��' Orono, MN 55356 a p/d -Q Q�jl 3 Cf <br /> RxEs�Og 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. ��� OD� <br /> Incomplete app�ications will be returned. (Please print) �/��'��� �' 'c���t.f-Q,S <br /> GENERAL INFORMATION: �8S�g JA " <br /> Job Site Address: � r; 1 ��,r,� , �1 - ne�e55�-y <br /> Will this be a Parade of Homes�, Remodeler Showcase Home or other Display Home? ❑Yes ❑ No�� /�C' <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prror to the event. Shuttle bus service wilf (� <br /> requi�eii unless applicant demonstrates sufficient on-site parking is available. Non-permitted events wil!not be allowe <br /> CONTRACTOR/APPLICANT INFORMATION: U' (��� , ����� <br /> N am e: � -1 � (--� <br /> 5tate License# Z.O 3� ' Expiration Date: 'S%?,l y '3 <br /> Phone: `i �- - Zc, office �Z(o - 4'Z.� '� 3 0 � cell <br /> Mailing Address: 4Z oo �2.�1 ► �i Cit : V) ' „��.- ZIP: �5 3r� <br /> Contact Person: � cr-._. Applicant is: ontractor / Homeowner (CircleOne) <br /> Email and/or Fax: ,, �:. ►�sc, ' � L 1 <br /> PROPERTY OWNER INFORMATION: <br /> Name: � �'' �'`L' <br /> Phone (day): ZIP: <br /> Address: City: <br /> Email and/or Fax <br /> ARCHITECT!ENGINEE�t I�1�RMATION: <br /> Name: �� <br /> Phone (day): City: ZIP: <br /> Address: - <br /> Email and/or Fax: <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 Residence <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&permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed Distnct(MCWD) ❑Other. (specify) <br /> 1520�Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> f'hone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Esiimated Construction Valuation (excluding land) $ i � 1 � <br /> ��� �o ��,� � <br /> � <br />