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r <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> O MailiPO Boxr66 Permit number. <br /> 0 Q Crystal Bay, MN 55323-0066 Date received: oz <br /> At Street Address:' Received by: <br /> int Gtii4 2750 Kelley Parkway Plan review fee: r L/L 7 cT`7 <br /> sgog�' Orono,MN 55356 �R_a <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us Total Fee: <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: 1"d z 0 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other DisplayRome? ❑ Yes 2rNo <br /> ffyes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus servi will le <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: \\ <br /> Name: L State License 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: 6� i7�1f�?% <br /> Phone(day): _ /L 721 <br /> Address: A-g zip City: ZIP: <br /> Email and/or Fax --r->`„ y„gys��1►��� ,Pt,(,y Cart^ <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 /> ❑ w Construction Water Supply <br /> ❑Single Family with ❑Residence <br /> -PNAddition attached garage ❑G ge/Accessory Bldg. El Public Sewer <br /> Accessory Building ❑ Single Family with <br /> ❑Relocation detached garage ❑ ce/CommercialPrivate Sewer <br /> El Other(specify) [3Multiple Family/Condo ElWarehouse <br /> ❑ Public ❑Storage ❑Public Water <br /> * Any earth movement may require ❑Commercial ❑Other(specify) <br /> MCWD review&permits. ❑ Industrial vate 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 a� <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation(excluding land) $ <br /> Packet Last Updated: 10-20-2011 <br /> -20- <br />