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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 -�a 7 <br /> .�Q�O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: $� - ( <br /> StreetAddress:' Received by: � <br /> � 2750 Kelle Parkwa 9��� <br /> y� ,G' y y Plan reviewfee: � /05.y � � <br /> c,` Orono, MN 55356 <br /> ��kFgHO�� Main: 952-259-4600 Total Fee: o?D/3 -D!�S�'7 <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 will be returned. (Please print) <br /> GENERAL INFORMATION/��� � s�r <br /> Job Site Address: �d�. � <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 su�cient on-site paiicing is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: � L.LC. <br /> State License# Expiration Date: <br /> Phone: cefl Z- office <br /> Mailing Address: � Cit : - tl�, ZIP: � / <br /> Contact Person: ( Applicant is: ract / Homeowner (Circle Onep <br /> Email and/or Fax: .�, �� . Co <br /> PROPERTY OWNER ORMATION: <br /> Name: �j ,4�'�i�:�-'Z <br /> Phone(day): Z- - <br /> Address: / 1� �� � City:�Uvtc� ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: �.�-��,�-�c-c�- <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <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) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public 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.or <br /> Estimated Construction Valuation (excluding land) $ ,' ��� —� <br /> --r <br /> Packet Last Updated: 04/19/2013 <br /> Page 22 of 23 <br />