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<br /> City of Orono ' � (��t
<br /> Building Permit Application �
<br /> for New Structures or Additions
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<br /> Mailing Address: d e " `ber` � "t��s�' wr ' ' , �, �� ,3-Qb21
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<br /> ��' � Crystal Bay, MN 55323-0066 Dat� oe V�'�����r�+>''� � � �` '' � ' � �
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<br /> ��, �ti 2750 Kelley Parkway �ph��F �ieW�eerit�� . 4 .��; tO,J.�9
<br /> ly S,,*� Orono, MN 55356 �,�,µ�� �����fi� �� y � �� �
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<br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us ����,A ,1�;�<;;�+��s�a�'�,��,���'�s,r�,t Y�'a � y'���
<br /> This application�fo`'� �` st e�� � e �tS�@a ;e�e�,��p'fo�matlon,mUst:be,sub,m�t#ed.
<br /> �neo , �[e_e���pp i�a io�s wil��,�,ef�,�tur�e„ (Please print)
<br /> GENERAL INFORMATION:
<br /> Job Site Address: � �d� ��1�c -� ��
<br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No
<br /> If yes,a special event permit is repuired with Police Department and Ciry Council approva/60 days prior to the event. Shuttle bus service will be
<br /> required unless applicant demonstrates sufficient on-site parking is available. Non-pe�mitted events wlll not be allowed.
<br /> CONTRACTOR/APPLICANT INFORMA?ION: 1 I
<br /> Name: �' �..,�. ����. -� f—I�-rv�� " c.
<br /> State License# �C(����.3�! Expiration Date: 3/ I � �
<br /> Phone: 'f C,�— 4'f G�— 4Y.��'t� (office) `T(,�— Z4Z— Z�a�► (cell)
<br /> Mailing Address: 4�oc 1 ►��- �°� _ Cit : ;,�,,,_ ZIP: ����,�1
<br /> Contact Person: ��,,._. �„�� Applicant is: Contracto / Homeowner (Cfrcle One)
<br /> Email and/or Fax:
<br /> PROPERTY OWNER INFORMATION:
<br /> ,,
<br /> Name: ,ti1�r'��: ��L��� ���
<br /> Phone (day): ��z � ���i- `i��"7
<br /> Address: City: ZIP:
<br /> Email and/or Fax �� ���._:�,�s� �; ,_.,...:-� � . �
<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 &
<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 Famity/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 /> Phone: 952-471-0590
<br /> Fax: 952-471-0682
<br /> www.minnehahacreek.or
<br /> Estimated Construction Valuation (excluding land) � � y Z 1 � � �
<br /> Packet Last Updated: 03-06-2012
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