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. � <br /> �� � <br /> City of Orono � l � <br /> Building Permit Application � <br /> for New Structures or Additions <br /> � Mailing Address: <br /> O�O,�.O PO Box 66 Permit number. - U_ <br /> Crystal Bay, MN 55323-0066 Date received: -/ <br /> � `° Received by: <br /> ,� � ,, y`_ �, StreetAddress:' � �� �� <br /> '�',�, '� '��'_ �titi 2750 Kelley Parkway Plan review fee: , <br /> t9kE5H 4`� Orono, MN 55356 ���� f�� <br /> '—_' Tota l Fee: ���3 —� <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: � � �3 � Pti� ,;n�n � �. ►�L,,,._. <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a specia/event permit is required with Police 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 wiU not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: � [ -�o�r�..1so� 1-�o,r,-�,� <br /> State License# ' 3q Expiration Date: � �3 <br /> Phone: '-1 — - �(L:� office 7 3 •- Z�L- "t ' � � cell <br /> Mailing Address: �( � C, Cit : ��, ZIP: 3 `7 <br /> Contact Person: � ��,,,..` Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: �G ti�����-, � �S,�n,,,_�,_ ����.v�s, ; Cs.,,.--,-„� <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP: <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 /> �ew 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: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ `��j Z Z \ <br /> —� <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />