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- � City of Orono <br /> � <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: ��' —r^ <br /> .�Q A, PO Box 66 Permit number: � <br /> ��'� Crystal Bay, MN 55323-0066 Date received: <br /> StreetAddress:' _��----,. e ived by: -� � <br /> 2750 Kelley Parkway 2�6 �C� <br /> y� � � P� review fee: �j . <br /> G`� Orono, MN 55356 ._ <br /> -----_ - - — <br /> '�x�s�o��' Main: 952-249-4600 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: <br /> Job Site Address: `3223 St-N�D�WoOh r�G+-E <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 approval 60 days pnor to the event. Shu le bus seiviee will be <br /> required unless applicant demonstrates sutficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: C!-{P•RI.E.""5 C.t,�p0 Go. L..1...G . <br /> State License# I�G (03 5 Z�-S Expiration Date: '3 _ 3� - Z,p�q <br /> Phone: (cell) ��7 , ¢�p • Z(�-Z (office) �!Z- 3 S`�- 170� <br /> Mailing Address: 5'O Z � Cit : rlou ZIP: �' ¢ <br /> Contact Person: ��,-� �„�e J�-T Applicant is: ontrac o / Homeowner (Circle One) <br /> Email and/or Fax: s��cl�f'1' ��F�s1zl,�-SCt�dp • Go]� <br /> PROPERTY OWNER INFORMATION: <br /> Name: v C��'S�un(D C,o� t-•l--G- i <br /> Phone (day): t.,�- �_(�o� City: �t.Zl�''�o u7� ZIP: �5���' <br /> Address: � Sip Z3M� /�V� ►� � <br /> Email and/or Fax SLt�b�(�'-C� CN�Jzt,�""SCt��r�C�l� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: CN��"''S C ta,o� Co• L•l- •G� <br /> Phone (day): (,(Z-- 35'�l- j709 c�ty: p�Yrtovt�.< ZIP: s$�¢7 <br /> Address: /SUSO Z3� A�I/t . /�/� <br /> Email and/or Fax: SL�L�FT�° C/�Fi42LE'SG+..IDl7 C.v/ti( <br /> PROJECT INFORMATION: Description of ro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> �New Construction �'Single 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 ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater � Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> � <br /> Estimated Construction Valuation (excluding land) � 4 l� �QdO `"� <br /> Packet Last Updated: August 2015 <br /> Page 2 9 <br />