2012-01245 - new structure - Laserfiche WebLink

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.! t Cit of Orono � 'd�' y 5 ��- b� Building Permit Application �- �1�� for New Structures or Additions '� Mailing Address: Permit number: p�� —�/ j.¢,�,�. PO Box 66 � Crystal Bay, MN 55323-0066 Date received: ` 1/ 1"'r'� � � , �„� Syt� �,�� StreetAddress:' Receivedby: - - ----- --- � � - I �\ �� G�i 2750 Kelley Parkw n � ', ,l 2 � Plan review fee: C . _'�� I �R�q.Esiio�,,� Orono, MN 5535 :C�(�l� Q�.__.�._ � � �� __ _ � a ____ __.___ . -�---,-_- Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (P/ease print) GENERAL INFORMATION: Job Site Address: ;��,�.�_, �i\, •�� r�� ;� � �.--: Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No If yes, a specia/event permit is required with Police Department and City Council approval 60 days pnor to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be al/owed. CONTRACTOR/APPLICANT INFORMATION: Name: �:�.;...._ `:��v��-� � �,�_� ,L��-- State License # '�� v Expiration Date: '-�(-31 1 � Phone: '( �- � - - office �� ,- �z„4. - -� cell Mailing Address: �; � � ' � � Cit � __ ZIP: Contact Person: L �c...�-.- Applicant is: ontractor '� / Homeowner (Circle One) Email and/or Fax: �h._,�n..��,�(�..L.,,._„_ ��Ir�,.�a� i�;,,,�;� �`..--�-.� PROPERTY OWNER INFORMATION: Name: !�-:-,; Ic�l�c��tc �___ Phone (day): ( c�: 'z C_ .' -�=`�_l", Address: 'S`/2.'" i;'x�E 2 ('��. .�j ,��. City;'si ��<< < f�,,� r ZIP: :,°�":�'�7<<. Email and/or Fax r"-7�,;�� s-�?-1- 1��.'� '� ARCHITECT/ENGINEER INFORMATION: Name: Phone (day): Address: City: ZIP: Email and/or Fax: PROJECT INFORMATION: 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& Water Supply �cNew Construction �Single Family with Residence U Addition attached garage ❑�Garage/Accessory Bldg. ❑ Public Sewer ❑Accessory Building ❑ Single Family with ❑ Deck ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse ❑ Public ❑ Storage ❑ Public Water "*Any earth movement may require ❑ Commercial ❑ Other(specify) MCWD review&permits. ❑ Industrial ❑ Private Well Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) 18202 Minnetonka Blvd Deephaven,MN 55391 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or Estimated Construction Valuation (excluding land) $ � ��_,