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. RECEIVED <br /> City of Orono JUN 13 2017 <br /> Building Permit Application <br /> for New Structures or Additions CITY OF ORONO <br /> ,r..---._ Mailing Address: � 1��r-r'7 <br /> `/r�Q�rO\ Permit number. / v�/ <br /> PO Box 66 <br /> `V � Crystal Bay, MN 55323-0066 Date received: —/�j —� 7 <br /> � Streef Address:' Received by: � /1�7 <br /> �';r��, tiw � 2750 Kelley Parkway `��Q. � <br /> \� 1 c`.� Orono MN 55356 Plan review fee: <br /> ��K��sFt��`� Main: 952�249-4600 Total Fee: ��� �j�fl�3 <br /> Fax: 952-249-4616 vw✓w.ci.orono.mn.us <br /> This application form must be completed in full and all required informatian must;be submiYted: <br /> incomplete applications wiil be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � ��,� �-.;�� t- `)L , � �` �' �'�,� <br /> Wili 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 rs available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: T� ' �z S <br /> State License# ' ' Expiration Date: � � -- � <br /> Phone: cell � � - - �� O office • t - -'�.']�;'y <br /> Mailing Address: '3 �O 1 , � r Ci • c � c�.� ZIP: �5 .3 <br /> Contact Person: r- ` �� �-}- Applicant is: Contfacto / Homeowner (Circle One) <br /> Email and/or Fax: � �,� -j..}- � �f�, hprrn� � n . �Lyy� <br /> PROPERTY OWNER INFORMATIO <br /> Name: '�,' ;�. ' �'� <br /> Phone (day): �'j ..� -(��_ -- p "� <br /> Address: Ci : ZIP: <br /> Email and/or Fax }�� r�,�� � � �\ . (,, �"M <br /> ARCHITECT/ENGINEER INFOIj�MAT40N: <br /> Name: (jh�: r��,r.� <br /> Phone (day): - y �- � <br /> Address: ' � _ � zl u�, �" Ci : ��= C�fS ZIP: � � �7 <br /> Email and/or Fax: 'rP�c>. ��x, u 6.;1 . i..�M <br /> PROJECT INFORMATION: Description of pro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> �'New Construction �Sin le Famil with Water Supply <br /> g y ❑Accessory Bldg. /Garage <br /> ❑Addition attached garage ❑ Deck �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage �Residence ❑ Private Sewer <br /> ❑Other: (specify) ❑ Multiple Famity/Condo Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> '*Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review 8 permits. ❑ Industrial ❑Warehouse �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other:(specify) ❑Other(specify) <br /> � 15320 Minnetonka Blvd I <br /> Minnetonka,MN 55345 <br /> Phane: 952-471-0590 <br /> Fax: 952-471-0682 <br /> � www.minnehahacreek.orq <br /> �� 1 1 `1 �i <br /> Estimated Construction Valuation (excluding land) $ .��(,1 Ci �L <br /> Packet Last Updated: August 2015 <br /> Page 2 i <br />