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t <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: <br /> 0PO Box 66 61,3-6 f o7b <br /> g, . <br /> 011 <br /> Crystal Bay,MN 55323-0066 Date received: �0-0)3-1;-,O <br /> a a Street Address: <br /> Received by: <br /> ,t Gtiti 2750 Kelley Parkway Plan review fee: <br /> .agzsxo4t�' Orono,MN 55356 <br /> Total Fee: 7 a , <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: 2 <br /> Job Site Address: u3S <D0 Ct tQ <br /> Will this be a Parade of Homes, Remodelers 9howcase Homd or other Display Home? Yes ballo <br /> ff yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service 6ill 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: COf v,o S'-froze l S <br /> State License# Al1A Expiration Date: <br /> Phone: z- ( office cell <br /> Mailing Address: ft Aw Ci /okfo ZIP: <br /> Contact Person: j � ; c CApplicant is: Contractor Homeowner (circle one) <br /> Email and/or Fax: <br /> PROPERTY OWNEI�,IrIFORMATION: <br /> Name: ( �y✓ 0 �s� 44, Z-75? <br /> Phone(day): 0(,57- - - V1 <br /> Address City: Q/oKo ZIP: SS3S <br /> Email and/or Fax MVI U <br /> ARCHITECT/ENGINEER I FORMATION: <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 /> ❑ New Construction ❑Single Family with esidence <br /> cessory Bldg: <br /> ❑Addition attached garage Garage Ac ❑Public Sewer <br /> WkAccessory Building ❑ Single Family with ❑Deck <br /> LJ Relocation 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.mi n nehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ( Q CO <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />