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� �� , <br /> �� ��� <br /> � �� <br /> 5�/l��D �p��• <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: O D - <br /> �g,D,�.O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> �' ��^' Received b <br /> �',��,� ��,�,�°�,,`>°� �, Street Address:' Y� <br /> . <br /> ��'s' � �;�5 ti 2750 Kelley Parkway Plan review fee: . <br /> t <br /> \L''��� �G Orono, MN 55356 aQ/O - ooa 9� <br /> ��`�gEsxo�' <br /> --- Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mr:.us <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: ! �f�7 /V�/�(,�� ��� )Illi <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> !f yes,a special 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 available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: /1/}JYI/1//�.- I' f'�'!'L`'/ �NS�i !i�''i,� <br /> State License# Expiration Date: <br /> Phone: (office) (cell) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: � G <br /> Phone (day): <br /> Address: I /� Cit : OfJN Z�P: � s3�3G� <br /> Email and/or Fax �7-f�p�,lfp/viy�:�s"2 � �/Y�/L.�O/'1'I <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: /v0/J//; <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 Family/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: (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) $ Q �(� <br /> Last Updated: 9/29/2009 <br /> - 17- <br />