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�� <br /> . City of Orono <br /> � � Building Permi� Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> �A,. PO Box 66 Permit number. ,- �`.;'� – L: ?j - <br /> � l vQ � Crystal Bay, MN 55323-0066 n � Date received: �� �� �1 –/b <br /> � h 0.� <br /> i Streef Address:' � Ig •�� Received by: � �v/u.C. <br /> y ,�' � /� 2750 Kelle y Parkwa y I P l a n r eview fee: �0 9 S � <br /> �' �` \� Orono, MN 55356 � <br /> ��k f s x o�`` ` M a i n: 9 5 2-2 4 9-4 6 0 0 Total Fee: ����r O� 3 <br /> Fax: 952-249-4616 wwv�,�.ci.orono.mn.us ��>����'v � <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: �� �.�� <br /> Will this be a Parade of Homes, Remodelers howcase Home or other Display Home? ❑ Yes ❑ No <br /> /f yes, a special event permit is required with Po/ice Department and City Council approval 60 days prior to the event. Shutt/e 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 INFORMATI <br /> Name: n � � �s r <br /> State License# Expiration Date: Z p�� <br /> Phone: cell �. s office � N� b`'�'i1d <br /> Mailing Address: 3 ; e Cit : ZIP: S� <br /> Contact Person: (�� Applicant is: ntractor / Homeowner (Circle One) <br /> Email and/or Fax: /� ` `T����„�� '�.��,�, <br /> PROPERTY OWNER INF RMATI N: <br /> Name: � � � h�.e� <br /> Phone (day): 'Z • 3 � — S�4 S � <br /> Address: Cit : ZIP: S�3 9 1 <br /> Email and/or Fax SSQI'Qi'lt'QP�U�OS �A�►i leY', C.OM <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP� <br /> Email and/or Fax: <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: _ Cit : 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 /> ❑ New Construction Sin le Famil with �Nater Supply <br /> g y ❑Accessory Bldg./Garage <br /> 0'Addition attached garage ❑ Deck �ublic Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ O�ce/Commercial <br /> ❑ Relocation detached garage �esidence ❑ Septic <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) (Compliance certificate <br /> ❑ Public 4-feet or greater may be required) <br /> "Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Public Water <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other:(specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd; Minnetonka, MN 55345 ❑ Private Well <br /> Phone: 952-471-0590 / Fax: 952-471-0682 <br /> www.minnehahacreek.ora <br /> Estimated Construction Valuation (excluding land) $ <br /> Packet Last Updated.� January 2016 <br /> Page 21 <br />