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City of Orono � �`� <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: <br /> O�,O�O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' Received by: <br /> 2750 Kelley Parkway �� Plan review fee: r` �� �/C fF 7 `7 <br /> L9kESHOg� Orono, MN 55356 <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us Qtw: <br /> This application form must be completed in full and all required information must be submitted. <br /> GENERAL INFORMATION: <br /> Incomplete applications will be returned. (Please print) <br /> �- / <br /> Job Site Address: �� ��yjJ �/ �,��' �/�,� s�3�� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other DisplayRome? ❑ 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 servi will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: J/1';" 7_� '— <br /> State License# Expiration Date: <br /> Phone: n _ (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: ��`✓a�r Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax -7-//,l <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP..— <br /> Email <br /> IP:Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> e <br /> wConstruction Water Supply <br /> ❑ Single Family with ❑ Residencedition attached garage ❑G a e/Accesso Bldcesso Building g Accessory 9 El Public Sewer <br /> Accessory g ❑ Single Family with k <br /> ❑ Relocation detached garage ❑ O Ice/Commercialrivate Sewer <br /> ElOther: (specify) ❑ Multiple Family/Condo ElWarehouse X <br /> ❑ Public ❑Storage ❑ Public Water <br /> —Any earth movement may require ❑ Commercial ❑Other(specify) <br /> MCWD review&permits. ❑ Industrial ivate 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 `� 7 <br /> www.minnehahacreek.ora CJ v <br /> Estimated Construction Valuation (excluding land) $ <br /> Packet Last Updated: 10-20-2011 <br /> -20- <br />