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, . , . <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: a?D�3 -Da 7 <br /> .�O A rO PO Box 66 <br /> `� Crystal Bay,MN 55323-0066 Date received: $- — � <br /> Street Address:' Received by: � <br /> 2750 Kelley Parkway Plan review fee: � �0 5•� � 9� <br /> ��� ��� Orono, MN 55356 O/3 �OD S�7 <br /> qKFSHO��' Main: 952-259-4600 Total Fee: a <br /> 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 wilt be returned. (Please print) <br /> GENERAL INFORMATION:/�/ � � � <br /> Job Site Address: � �c%�- <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes,a specia!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 s�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �T.:.L ��� <br /> State License# p Expiration Date: <br /> Phone: cefl Z- office <br /> Mailing Address: Q Cit : - ZIP: — / <br /> Contact Person: ( Applicant is: ract / Homeowner (Cir�le One► <br /> Email and/or Fax: �+. s L . Co <br /> PROPERTY OWNER ORMATION: <br /> Name: ��� ��,,a-�,+i-�.z--Z <br /> Phone(day): (,lZ-1�����L City:�avtc� ZIP: <br /> Address: / /�����.� <br /> —,�_._:. <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: �.��,��a-c� <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal& <br /> Water Suppfy <br /> ❑ New Construction �X 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/Cqmmercial ❑ Private Sewer <br /> Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Pubfic Water <br /> **Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review 8�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.minnehahacreek.o <br /> Estimated Construction Valuation (excluding land) $ �_��� _ <br /> Packet Last Updated.� 04/19/2013 <br /> Page 22 of 23 <br />