Laserfiche WebLink
f �P <br /> City of Orono �, V�� <br /> Building Permit Application � ,�--� � <br /> for New Structures or Additions �N'��l <br /> Mailing Address: Permit number: �� "a� �� <br /> �Q A TO PO Box 66 , / <br /> `w Crystal Bay, MN 55323-0066 Date received: � "7' � <br /> StreetAddress:' Received by: <br /> � ,� 2750 Kelley Parkway Plan review fee: <br /> F c,` Orono, MN 55356 <br /> t�kFSHO�� Main: 952-259-4600 Total Fee: <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. (P/ease print) <br /> GENERAL INFORMATION: j <br /> Job Site Address: � ��� (;����1 � <br /> Will this be a Parade of Homes, Remodelers S case 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 sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: ,.�/� , � � � �Il , �Q/ S�. <br /> Name: /' I( � V� � <br /> Phone (day): � �� , /1 ,� <br /> Address: � ��b wG�C'C � Cit : ��„��1 �(1 ZIP: �j' ��� <br /> Email and/or Fax 1'ti 1 fL � ' n � 1 N ' �'� �.�'1 <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <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 8� <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑ Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. �Public Sewer <br /> ❑Accessory Building f�Single Family with ❑ Deck <br /> ❑ Relocation � , ,� detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) L U��^ �. ❑ Multiple Family/Condo ❑Warehouse <br /> /�ei;✓ �i� ❑ Public ❑ Storage ��Public Water <br /> ""Any earth movement may require ❑ Commercial ❑ Other(specify <br /> MCWD review 8�permits. ❑ Industrial L!`f�N � ❑ 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) � � / �O ' <br /> Packet Last Updated.� 04/19/2013 <br /> Page 22 of 23 <br />