Laserfiche WebLink
1 <br /> � ' , � � �� <br /> . City of Orono � �'� <br /> � <br /> � � <br /> Building Permit Application i �i� <br /> for New Structures or Additions <br /> _ _ Mailing Address: Permit number: / �' " �� ��` <br /> �,�Q� PO Box 66 /� • <br /> ,Q� �� Crystal Bay, MN 55323-0066 Date received: <br /> � �� Received b . <br /> ��. ,,�..�, ` y. <br /> �� "�l� 1 p„I! Street Address:' <br /> � ��`J �/ 2750 Kelley Parkway Plan review fee: ' '• <br /> . C <br /> �r '.1,,��• �'��' Orono, MN 55356 .��,/�-C CT�c� " <br /> R��'SKOg Total Fee: <br /> Main: 952-249-�1600 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: � �� Q ►11���.. t�- �,o.r�..- <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Dispfay Home? ❑ Yes ❑ No <br /> If yes,a special event permit is required with Polrce Department and City Council approva160 days prior to the event. Shuttle bus service wil!be <br /> requirecl unless applicant demonstrates suffrcient on-site parking is avarlable. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: � <br /> Name: � � �n. � <br /> State License# Z..O �3 Lt- Q Expiration Date: 31`3 i � 3 <br /> Phone: `[ �,- - 'Z,:c, office '7 to - 4'Z� 1�G � cell <br /> Mailing Address: 4-'[oo �1?-.�_ ► �i Cit : vl � ' ,.��- ZIP: S S 3�.� <br /> Contact Person: F� c�--.- Applicant is: ontracto / Homeowner (Circle One) <br /> Email and/or Fax: � c� ►�c, `' L t <br /> PFtpPERTY OWNER INFORMAT <br /> Name: ��nLa.. ��G.c.s� j^�^� <br /> Phone (day): ZIP: <br /> Address: City: <br /> Email and/or Fax <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& <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 District(MCWD) ❑Other: (SpeClfy) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> P hone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 1 tv�,O O V <br />