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r <br /> . . , <br /> . � <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> .�Q A,.O PO Box 66 Permit number: <br /> f w Crystal Bay,MN 55323-0066 Date received: <br /> Street Address:' Received by: <br /> -� 2750 Kelley Parkway <br /> �.� ,G� Plan review fee: <br /> c? Orono, MN 55356 <br /> �'�kFgyO�� Main: 952-259-4600 Total Fee: <br /> 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: �� � � c�Q� �!2 <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. ShutNe bus se�vice i e <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-pem►itted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMAT <br /> Name: c���� �s � Ib� <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORM ION: <br /> Name: �1{� q✓�'/ V�q �/`-- <br /> Phone(day): .C�CL �I U — �(o2lt <br /> Address: ���v Cit : V ZIP: sS3�l'� <br /> Email and/or Fax � y� Q v � v►�t,_. <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Q w�E�-- <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro'ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Suppty <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 p � <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ t�v0��' <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />