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, City of Orono <br /> ' Building Permit Application <br /> ` for New Structures or Additions <br /> Mailing Address: Permit number: O��—O� � <br /> ��?v�,j�\ PO Box 66 <br /> �o o� Crystal Bay, MN 55323-0066 Date received: �— —� <br /> ( _. <br /> �� ��� �- � Received by: %?(". _.___. <br /> 1��a y �� a,�, Street Address:' <br /> ��`t� .��',� ��� 2750 Kelle Parkwa / � �(� L�9 <br /> c� x: Y Y n Plan review fee: � <br /> \g ��'� 4/ Orono, MN 55356 /� ,,r � <br /> ,,_ESHo, _�ao��-o i3 <br /> _-___-, � <br /> Total F�:" __� �- <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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address �� �.y���'�� �o�,,� � � ��O�y a ��4� ,�'^J� ��J <br /> Will this be a Parade of Homes, Remo elers Showcase Home or other Display Home? ❑ Yes �No <br /> If yes,a specral 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 avaifable. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFOR ATION: <br /> Name: ,� �.c�'l <t �� �L,G , <br /> State License# �' Expiration Date: — /a <br /> Phone: — ���--. office cell <br /> Mailing Address � . x ,S""' Cit : ZIP: � <br /> Contact Person: �"',� N 7`�S Applicant is: ontract r / Homeowner �c���ie one� <br /> Email and/or Fax: �e�y� <br /> PROPERTY OWNER I MATION: <br /> Name: � hJ1�1�1- y�-j'Ll <br /> Phone (day): — '� — ,r� <br /> Address: — Cit : V"�C�hJ� ZIP: ���`J <br /> Email and/or Fax <br /> ARCHITECT/ENGINEEI�INFORMATION: <br /> Name: ,�,�`�7�%�— <br /> Phone (day): � <br /> Address: Cit : 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 <br /> ❑ Other: (specify) ❑ Multi le Famil /Condo ❑ Private Sewer <br /> p y ❑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 ��� �,i� <br /> Phone: 952-471-0590 ��� <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ / �f, Q pQ ,�� <br />