Laserfiche WebLink
_ _ ity of Orono �(,� �o� <br /> -�-�� Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: ��O - <br /> Og,�,jv.O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> ,� �° =� �, StreefAddress:' Received by: � <br /> �' � � ti 2750 Kelle Parkwa <br /> c� � Y Y ��� ����, Plan review fee: -- �Q <br /> t9kE5Ho4� Orono, MN 55356 <br /> Total Fee: /�� /O <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and ali required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: �f � <br /> Job Site Address: � ��`' / �/ � � �� , <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> If yes, a special event permit rs required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless appficant demonstrates sufficient on-site parking rs available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: � � � � <br /> Name: �-�-c�� S'��o�e✓�i�q (C �av� S � v� � b v� �--L � <br /> State License# Expiration Date: <br /> Phone: (9 �Z �1�{� �5�j'�j (office) (cell) <br /> MailingAddress: _ �,<y�� C ;��5� ( ,�,�,, /3� City: ���iy,��; ; ZIP: Ss"3i/ <br /> Contact Person: ' ' Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: � <br /> PROPERTY OWNER INFORMATION: <br /> Name: - ,.a�� +=j C-���S��.� <br /> Phone (day): <br /> Address: `7 7G oo-��> i�Q <� �i— CitY� �Z�,v v�,n c ZIP: _j�,5 C </C7 <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 & <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 ,�.IIesl���Ck.1 I'Z,�� <br /> ❑ Relocation � detached garage ❑ Office/Commercial-}Q ❑ Private Sewer <br /> Other. (specify) �c=�iu � ��'�0 ❑ Multiple Family/Condo ❑Warehouse j..�c.� <br /> ❑ Public ❑ Storage �n�V _ ❑ 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) $ � �3G <br /> Last Updated: 6/22/2009 <br /> - 19 - <br />