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, , ,. <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: 0���OD <br /> ��v�,� PO Box 66 Permit number: <br /> 0 �\ Q Crystal Bay, MN 55323-0066 Date received: / 020 <br /> a <br /> �' �.e-�:;�. a, Street Address:' Received by: �� <br /> �'� � 'tl� �� 2750 Kelley Parkway Plan review fee: ` <br /> r`�x'�sxo4'� Orono, MN 55356 <br /> Total Fee: ���. �j�� _ <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. �: c) <br /> Incomplete applications will be returned. (Please print) �� -�"�j <br /> GENERAL INFORMATION: <<� <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 specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service wi//be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFQRMATION: <br /> Name: ���� ���,� <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: Cit : P: <br /> Contact Person: Applicant is: Contractor ! Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �c��u�� �- ���v'a ut �C q C�f�S� a'1 <br /> Phone (day): �'j�"� �,(�_�2�� <br /> Address: � �C'%1/c^�ti 64-,.�w.... �'Jr City: ��Ac�,.,.�� ZIP: S`"5—.3�� <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: ' .. <br /> Name: �'f"e�-e ���a r E ✓� r q /C, -- �_��1-�—'�'J-e �.-� �r-- <br /> Phone (day): (� ( z.- � y� c'�$-S/ <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 /> New Construction Water Supply <br /> �' ❑ Single Family with ❑ Residence <br /> �❑ ddition attached garage �Garage/Accessory Bldg. [�}Public Sewer <br /> Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse ❑ Private Sewer <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: (Spe ify) <br /> 18202 Minnetonka Blvd � G e <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ��� pp�. <br /> -20 - <br />