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. . . ' ,. ��✓'� <br /> City of Orono � <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: O?�` —�d <br /> O�,�,�.0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: .� ,�—�v� <br /> ,� .; �, StreetAddress:' Received by: <br /> `$',� GtiiS' 2750 Kelley Parkway Plan review fee: � <br /> t�kESH�g'� Orono, MN 55356 <br /> Total Fee. o��S, e�3 <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. (Please print) <br /> GENERAL INFORMATION: � <br /> Job Site Address: .�5��� 1��, uf' �1\`. �C����,% � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? � ❑ Yes No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service ill e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMAT N: <br /> Name: � <br /> State License# ' p• -Q 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 INF RMATION: <br /> Name: �-yc <br /> Phone (day): . S' / <br /> \ P i <br /> Address: ��G Cit : � ZIP: v �1'� <br /> Email and/or Fax � <br /> ARCHITECT/ENGIN�R 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 8� <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 ��`O her(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 / / � }� <br /> Phone: 952-471-0590 d b k b �'X��.� N/� yJ��� <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � ��1 <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />