Laserfiche WebLink
City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mai PW►g0 Box 68� ?errtiit number. (c,�—r'� � 11.�3 <br /> �`v0 Crystal Bay.MN 55323-0068 p��: -- �� <br /> SYreetAdd�ess:' Ret�edt►Y; �- � � <br /> y'" c?� ZOrono,MN 58356 y ?lan revbwlee: �.`T�V�Q-. I1�'YY�f�P�C�-�U <br /> T� <br /> 4't SNOa� lylaln: 952-24&4800 Tr�Fee: � . .. . . � <br /> Fax 952-24&4616 www ci.orono.mn us <br /> Thl8 BppNC8110f1�rtll�b8 O�I�18�Bd k11Ud 811d iN I�Qt�180 NI/Off1�0111iNJEt b8 EUbRlll�Bd. <br /> In�pleEe aPplkatlons wNl M rstumed. (P�ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: I$'�9 �I�LJ �' <br /> Will tl�is be a Parade o Homes,Rem lers Showcase Home or other Display Home? ❑Yes ❑No <br /> H yae,a syedel eveM permlt ia reqWred w(th Potioe Depertment end City Coundl apprtiva/80 deys prior to Me event. ShuCle 6us servke wi/l be <br /> repulred unleas eppliaant demonsbatea sufiaenf on-slte psAdng is eveNabN. Non-pem�fted eueMs wB!not be allowed. <br /> CONTRACTOR 1 APPLICANT INFORMATION: <br /> Name: _�V���� <br /> State License# Expiration Date: <br /> Phone: (celq ���� <br /> Mailing Address: --- Cily: ZIP• <br /> Contact Person: Applicant is: Contractor / Homeowner �a�cN o�.� <br /> Email and/or Fax: <br /> PROPERTY OWNER INFO T <br /> Name: � <br /> Phone(dey): <br /> �d�: c� drono ZIP <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMA710N: <br /> Name; <br /> Pho�e(day): <br /> Address: Cilv: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri ' n of ro' 1� �� <br /> 1.Type of Project 2.Proposed Uae S. cture 7ype 4.Sewage Dbposal d� <br /> Water 8upply <br /> ❑New ConsUvction ❑Single Family witl� ❑Accessory Bldg./Garage <br /> ❑Addition attached earepe � ❑Public Sewer <br /> ❑Axessory Building ❑ Sinpb Famity with �Yfice/Commercial <br /> ❑Relocation detached garage ❑Residenoe ❑Privete Sewer <br /> ❑Otl��er($PecifY) ❑Muttiple FamAy 1 Condo ❑Relsining UVall(a) <br /> "My qrfh movemsnt may roqulre ❑Commercial �S�e 9� ❑PuWic Water <br /> NICIND revisw 3 pwmits. ❑Indusdisl ❑wareno„$e p�vv�u <br /> Minnehahe Creek Watershed Distrid(MCWD) ❑p�e�(s�(y) ❑pyigr�speqfy) <br /> 15320 Min�nka BNtl <br /> Minnetonka,MN 56345 <br /> Phone: 952-471-05� <br /> Fax: 952-471-0682 <br /> . nehe <br /> Esbmated Construction Valuadon(exdudin�land) ; �,f'J'� <br /> Pecket Lest Updeted.'Augu�2015 <br /> Page 21 <br />