Laserfiche WebLink
City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: <br /> '¢+U\ PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 2 Z o <br /> Street Address:' Received by: T <br /> 2750 Kelley Parkway Plan review fee: <br /> L�rtE$xog� Orono, MN 55356 <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 /> GENERAL INFORMATION: Incomplete applications will be returned. (Please print) <br /> Job Site Address: 9i /"/a&7--1 S /'7 m.9 /� <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. Shuttle bus service 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: 44, - die- c.y 4rG (f-,7i2.4 /-7'si"h e All 010"",7da /1 eg-'4iV <br /> State License# p eq 4q _ p Expiration Date; ,2Q p O <br /> Phone: ,z office /.Z - -k& 7 -_?.21 cell <br /> Mailing Address: Or"Z_gsal #09 C i t6grz ovo,s 4*?IP: .6.f y-Z <br /> Contact Person: ,q v, ✓v/„�, o n Applicant is' ontractor omeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: �S'y / ��,-a,¢� --V7-,e2, la,j_?1 City: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFOR ATION: <br /> Name: ! ' <br /> Phone (day): <br /> Address: Citv. ZIP: <br /> Email and/or Fax.- <br /> PROJECT <br /> ax:PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> ❑ New Construction Single Family with Water Supply <br /> 9 y ❑ Residence alr�h <br /> ❑ Addition attached garage 4K-QaFaya/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> elocation 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 <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ <br /> -20 - <br />