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� � � City of Orono <br /> . � ��a � qaJ <br /> Building Permit Application �� <br /> for New Structures or Additions <br /> Mailing Address: Permit number: p� �/7 Q�� <br /> QA,. PO Box 66 <br /> � �VQ Crystal Bay, MN 55323-Oo�ECEIVE Date received: J'r'�.S/� <br /> 1� StreetAddress:' �QY Z 5 Z01� Received by: (�� °� <br /> ,� 2750 Kelley Parkway <br /> � '�' Plan review fee: / g 9 �'1S <br /> F �` � � Orono, M N 55 356 <br /> �'�k�'sHo�`�` Main: 952-249-4600 c�'�y 0�ORON Total Fee: ��� ��� S�' <br /> Fax: 952-249-4616 wwv��.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: �d O �� ..� ��,,- s t C�-�-, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes [��o <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 availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: � r ��_ �� _ (� <br /> Name: c�v� ec� or,�-,� V�Y <br /> State License# a � Expiration Date: <br /> Phone: cell �'� -� � -9c� office � • 60 <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: Applicant is: n c / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �ru v�Y-e� <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: Citv: ZIP: <br /> Email and/or Fax: <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& <br /> Water Supply <br /> ew Construction ingle Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence eptic <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 <br /> ❑ Public Water <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) ❑ Other(speCify) <br /> 15320 Minnetonka Blvd;Minnetonka,MN 55345 rivate Well <br /> Phone: 952-471-0590 / Fax: 952-471-0682 <br /> www.m innehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ <br /> Packet Last Updated: January 2016 <br /> Page 21 <br />