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1. <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address:0.� PO Box 66 Permit number: <br /> 0 4 C) Crystal Bay, MN 55323-0066 Date received: ./c, //p <br /> 7.4„, ..:., <br /> ' ``e ' 4'1 <br /> . Street Address:' <br /> Received by: L (-//e G`?.S 71- <br /> '� r 'ir,' <br /> 2750 KelleyParkway <br /> ..„ . ii1)±' ' �~ Plan review fee: <br /> 9kE3H04�' Orono, MN 55356 <br /> Total Fee: <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: S-5-3576 <br /> Job Site Address: 1 q5� O/' Jo C'fl s QX lye (Z C JuJ O I <br /> Will this be a Parade of Homes, Remodelers Showcase Home or ot'�er Display Home? El Yes MNo <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: <br /> State License# Expiration Date: <br /> Phone: (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: ,�J VName: R OAJ / / '6,�1/1//� / <br /> Phone (day): 9, -.07--- '9-3 c3 74, C�6, <br /> Address: /35-0 O) &VO 0X7k5 G1'fVE City: ./ 'JJ2'VO ZIP: 3—S3,376 <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: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction <br /> ❑ Single Family with ❑ Residence <br /> ❑Addition attached garage ❑ Garage/Accessory <br /> El Accessory Building ❑ Single Family with El Deck <br /> Bldg. El Public Sewer <br /> ❑ Relocation(specify) 5f/7 detached garage ElOffice/Commercial <br /> [Other: ,5 iD ID Private Sewer <br /> ❑ 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 11 --Kx/i1)P /v,/X0, � <br /> Deephaven, MN 55391 V"' <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ 02,i &"0--6tthi <br /> Last Updated: 9/29/2009 <br /> - 17- <br />