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. � �� <br /> ;� � �� <br /> City of Orono c 1�� <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: a�� �_p(�a <br /> �/�O,j� PO Box 66 Permit number: <br /> ,u� � Crystal Bay, MN 55323-0066 Date received: d�`,� / <br /> I j ��� <br /> 1',a �y �t�-�: a.�; Street Address:' Received by: <br /> �� �, y �� 2750 Kelle Parkwa <br /> \,�`';,'��?�;.�t�a. p Y Y Plan review fee: <br /> \� t�� '` 4� Orono, MN 55356 <br /> �_ Esi�o. <br /> ---�� Total Fee: I , r <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us J <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: � � �` , _.� �,,, , <br /> Will this be a Parade of Homes, Re odelers Showcase Home or other Display Home? ❑ Yes No k:�. <br /> lf yes,a special event permit is required with Po/ice Department and City Council approval 60 days prior to the event. Shuffle bus servrce will be ' <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. �`�' <br /> ,,. <br /> Gt, <br /> �.. <br /> CONTRACTOR/APPUCANT INFORMATION: <br /> Name: C��.�c3..,� rcee\��.��, <br /> State License# Expiration Date: <br /> Phone: — �y '"� office) cell <br /> Mailing Address: Cit : � • f'''� <br /> Contact Person: g Applicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: ' <br /> PROPERTY OWNER INFORMATION: <br /> Name: � Q �Q <br /> Phone (day): — —�-r,g <br /> Address: Cit :�'j� ZIP: S��_ �� <br /> Email and/or Fax � L c- <br /> ARCHITECT/ ENGI�ER INFORMATION: <br /> Name: 1�,r�.-� �.:+���ei <br /> Phone (day): �a---���—l��y� <br /> Address: �, c�c-,T,��ye'��5��� .� City: ���c,���� ZIP:Sti'��t-I <br /> Email and/or Fax: r���Q���,�.,�., �;-�� <br /> J <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Pro osed Use 3. Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction Single Family with ❑ Residence <br /> ❑Addition attached ara e ara e/Accesso Btd <br /> 9 9 0/G 9 ry g. ❑ Public Sewer <br /> ❑Accessory Buildi 1`\ \ ❑ Single Family with [� Deck <br /> ��elocation �e'c'r�n Y e c-�L�L detached garage ❑ Office/Commercial �nvate Sewer <br /> �'Other: (specify)��,,'y�� �� a�,< ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> �"'Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial �rivate 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) $ � �(�;�� �,�^ ;;�;� <br /> ;:� <br /> :':� <br /> • :.. <br /> � f�. <br /> � ti <br /> � ' � . <br /> ; � � _ � � � � � . � � � <br /> ; ; , .- <br /> .�„�. _ . . , <br />