Laserfiche WebLink
. <br /> ' City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �— ( <br /> � �Q PO Box 66 <br /> Q Crystal Bay, MN 55323-0066 Date received: '—� f 3— <br /> StreetAddress:' " Received by: <br /> � <br /> 2750 Kelle Parkw �k- �Z3 `7 j� o� <br /> y� c?� Orono, MN 55356 ���e�"`����"Y lan revi��e: �, ��5 �� <br /> qkfSHO�� Main: 952-259-4600 � -� �g '�1O'y <br /> ee: <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: <br /> Job Site Address: � �/d0 p,��'v��k! D�c��vc� <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 approva160 days prior to the event. Shuttle bus service w�ll 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: (� s <br /> State License# q(� Expiration Date: <br /> Phone: cell — office <br /> Mailing Address: � ?,o�� Cit : ZIP: S <br /> Contact Person: �'��yN�y Applicant is: a r / Homeowner (Circle One) <br /> Email and/or Fax: �����y���pQ�O� -'7�y�s. �0�✓I <br /> PROPERTY OWNER INFORMATION: <br /> Name: d �, <br /> Phone(day): � - Q <br /> Address: City: ZIP: <br /> Email and/or Fax , <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: -i- ,J <br /> Phone(day): 6 - _ ,$ c <br /> Address: v L �rt�: S . Cit : V 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 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) �Qther: (speCify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m i n n e h a h a c ree k.o r <br /> � O � <br /> Estimated Construction Valuation (excluding land) <br /> �- �� 3ag, �'y �� �. <br /> Packet Last Updated: 04/19/2013 � — _ ___ <br /> Page 22 of 23 ( � / ' c� <br />