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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: D Q•d14 <br /> 0,1 PO Box 66 — <br /> ;i� Crystal Bay, MN 55323-0066 Date received: D O <br /> li <br /> a IT11t �. Street Address:' Received by: <br /> 2750 Kelley Parkway Plan review fee: <br /> L'�xEs;o¢ Orono, MN 55356 <br /> Main: 952-249-4600 Fax: 952-249-4616 lwww.d.orono.mn.us Total Fee: 15w ?o <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: ZiG3 o 0 L�D B f:AC O RO'\%> <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes allo <br /> H 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: <br /> State License# Expiration Date: <br /> Phone: 9$Z 15a 3- (fob Z (office) R 5'L] 2 S 3 - 3 o 2.8 (cell) <br /> Mailing Address: 2,53o a --AC r2_9 City: WR 'a-TA4 ZIP: $S 9 I <br /> Contact Person: OA42-T i*-I e rz G RQA S Tl f-� (fEei-1Arz9Applicant is: Contractor / omeown (Circle one) <br /> Email and/or Fax: Marf;n8erkardI� ��,; I•cam <br /> PROPERTY OWNER INFORMATION: <br /> Name: MA6E-zRHAi`,0 <br /> Phone(day): QqS-2) ZSS- 3 o 2 9- 5Z) zSg -330 <br /> Address: 2�3o 6L-o F3,�-/rC H 20 City: WAY-2^--76 ZIP: Vyl Iy" S Q3 <br /> Email and/or Fax Mart,,. .c v V�\a J I c_vn� I -c cel <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 /> Water Supply <br /> ElNew Construction 91 Single Family with ®Residence <br /> g'Addition attached garage ❑Garage/Accessory Bldg. ® Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Deck <br /> ❑ 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 /> llwwwminnehah cr a .or <br /> Estimated Construction Valuation (excluding land) $ <br />