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4 <br /> City of Orono �� <br /> Building Permit Application <br /> for New Structures or Additions <br /> _ Mailing Address: Permit number. Z)`,J— fib/ <br /> PO Box 66 <br /> 0 : .r O <br /> Crystal Bay, MN 55323-0066 Date received: 1'_7— l� <br /> Street Address:' Received by: <br /> 2750 Kelley Parkway Plan review fee: 9 <br /> Orono, MN 55356 y 3!v O <br /> 9gE9H04c4zo <br /> Total Fee: v <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: -i23j O� D/e <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus servol�will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORM�IATION: <br /> Name: ��is On LILS m �lmt?S L- <br /> State License# Expiratio Date: <br /> Phone: (office) "X -,221—_9971 (cell <br /> Mailing Address: /6 i-✓ City: c / ZIP: 3 <br /> Contact Person: 0d Z 0/50-" Applicant is: rac / Homeowner (circle one) <br /> Email and/or Fax: req Jft� rc,Ax"I v ,P.n IVP, -c <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER 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 & <br /> Water Supply <br /> C9 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 IxPublic 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.minnehahag[ggk.or <br /> $ 7 ,� <br /> Estimated Construction Valuation (excluding land) ���Q� <br />