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City of Orono <br /> Building Permit Applicati®n <br /> for New structures or Additions <br /> Mailing Address: <br /> ®A, PO Box 66 Permit number: p�Oi7—D/D <br /> vQ Crystal Bay, MN 55323-0066 Date received: nJ <br /> Street Address:' Received by: <br /> y ,C 2750 Kelley Parkway <br /> Orono, MN 55356 Plan review fee: }/ <br /> SH L),9,. Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 vmmrw.ci.orono.rnn.us <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 /> Job Site Address: <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/APP CANT INFO,jRMATION: <br /> Name: o: <br /> State License # Expiration Date: <br /> Phone: (cell) �; .Z 2 W 7 (office) <br /> Mailing Address: ✓ , rY �� ' Cit Zlp. S 3 <br /> Contact Person: �d <br /> Email and/or Fax: Applicant is: Contract0r / Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: S`� S ;-� j r°� C� / -� Cit • l•% _-a' ZIP <br /> Email and/or Fax <br /> ARCHITECT / ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Citv: RECEIVacup. <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: Description of project: <br /> 1.Type of Project —7 <br /> 2. Proposed Use 3. Structure Type 4.Sewage Disposal & <br /> ❑ New Construction ❑ Single Family with ❑ Accessory Bldg./Garage Water Supply <br /> ❑Addition attached garage ❑ Deck <br /> ❑Accessory Building El Single Family with ElOffice/Commercial ❑ Public Sewer <br /> ❑ Relocatione J�Cf 4 detached garage ❑ Residence <br /> EI Other:(specify) j El Septic <br /> ❑ Multiple Family/Condo ❑ Retaining Wall(s) (Compliance certificate <br /> ❑ Public 4-feet or greater may be required) <br /> **Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review& permits. ❑ Industrial ❑Warehouse ❑ Public Water <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd; Minnetonka,MN 55345 <br /> Phone: 952-471-0590 i Fax: 952-471-0682 ❑ Private Well <br /> www.minnehahacreek.orc <br /> Estimated Construction Valuation (excluding land) $ �p <br /> Packet Last Updated: January 2016 <br /> Page 21 <br />