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. • <br /> . � City of Orono ��� �� <br /> � <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: � l! — .S/ <br /> O��,�.0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �p/2�� <br /> �''`'"''�'"'= Received by: <br /> t a '�'-� ,, � Street Address:� <br /> � �� �,,�' 2750 Kelley Parkway Plan review fee: <br /> \lqgESHog� Orono, MN 55356 <br /> �=___.-- �-a��.�� <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: <br /> Job Site Address: � a % ^ ' ', <br /> Will this be a Parade of Homes, Remodelers Showcase Home or oth r Display Home? ❑ Yes No <br /> If yes,a special event permit is required with Police Department and City Council approva160 days prior to the event. Shuttle bus service wil be <br /> required unless applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: ; , ��. �O,S�/tl <br /> State License# Expiration Date: <br /> Phone: ��� � � „ �.�� (office) (cell) <br /> Mailing Address: �� Cit : � ,,ti • . 3� <br /> Contact Person: �,I�y r,,,t, ,�,��,:>.v Applicant is: Contractor / omeowner � �c���ie o�e� <br /> Email and/or Fax: ��T�,1�� �� 5`'� C^T�La r� � �6�,� <br /> PROPERTY OWNER INFORMATION�:� /� <br /> Name: ����iiiJ V•-I�.S��� <br /> Phone (day): �����=��'� <br /> Address: �� City: ZIP: <br /> Email and/or Fax -�� �- /n <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P: <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 ❑ Residence <br /> ❑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) s` ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Pubtic ❑ Storage ❑ Public Water <br /> '*Any earth movement may require ❑ Commercial �Other(g cify)� <br /> MCWD review&permits. ❑ Industrial � b3�y '�'Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other. (specify) �� ���/� <br /> 18202 Minnetonka Blvd �' 1 <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 /> �_ <br />