Laserfiche WebLink
/���- , <br /> . . � <br /> �. ��-o <br /> � ��,� ��� <br /> City of Orono � � ����'��� <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: ��� — �� ,(/ <br /> �,�,�. PO Box 66 <br /> � � Q Crystal Bay, MN 55323-0066 Date received: <br /> �,T <br /> a, �'`��-��' �, Streef Address:� Received by: <br /> t,' ,s,.� <br /> �'�, ' ��r� �ti 2750 Kelley Parkway Plan review fe � <br /> r9kESH�4'� Orono, MN 55356 <br /> - Total Fee: p� � J��,39 <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: //�� M ��/� S77j,,�J f`� (> l�'Lv,UU <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> /f yes, a special event permit is required with Po/ice Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT I FORMATION: <br /> Name: �C ,N� o"iT� ' �� / �v C- <br /> State License# " 0 3�/ Expiration Date: 3 j/ Z <br /> Phone: _ ��o -- � �� office !2— 28 � 74�3 cell <br /> Mailing Address: -� 5'��'2E �- Cit : C �t-s�c�y✓ ZIP: �'S3� '7 <br /> Contact Person: v"T�' Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: - � r-�,,.�-r' f v. vT�1�, C � CdNt <br /> PROPERTY OWNER INFORMATION: <br /> Name: �v��✓��/ Q�,{.Yz�„f�L.L <br /> Phone (day): <br /> Address: Qc� �I�►�`(,(,SToN � City: �I��JU ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: 1312tc�:C ''t�wt,'7T �' �SS vC�'.�?ts <br /> Phone (day): �SZ— �/7 — �Z'Z� <br /> Address: �,J�yZi4-T/+ City: ZIP: <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) �l�D l7K ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "�Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review 8�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 �/� /� �1 �/1 / <br /> Fax: 952-471-0682 �G�l�-(� ` G��Y lq��Y — /G�OV 'l/G� �+1�J r�G ,�— C���i•� �-[f�C9� <br /> www.minnehahacreek.or / <br /> Estimated Construction Valuation (excluding land) $ c9 V�p , c�� <br /> Last Updated: 9/29/2009 <br /> - 17 - <br />