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� City of Orono <br /> " Building Permit Application <br /> - for New Structures or Additions <br /> MailiP���. Permit number: O��/.S� � /� p�J <br /> �O+YQ Crystal Bay,MN 55323-0066 Date received: d ��,3 —/ <br /> ! SYreetAddress:' __.., .Rocei <br /> y �f 2750 Kelley Paricway / L� <br /> '" c.` Orono,MN 55356 n Plan review fee: <br /> `AkfSH�p� Main: 952-249�600 `� U� � <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 retumed. (P ase print) <br /> GENERAL INFORMATIO : <br /> Job Site Address: Q . <br /> Will this be a Parade of H , Remodelers Showcase Home or other isplay Home? ❑Yes ❑ No <br /> H yes,a specia/event permit is requi�ed with Police Department and City Council approva/60 days prior to the event. Shutf/e bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is availab/e. Non-permifted events wili not be allowed. <br /> CONTRACTOR/APPLIC T INFORMAT ON• <br /> Name: ��� (�� l�f� <br /> State License# ��� <br /> �j( ?�GS' Expiration Date: 3 ..S -Le�'t. <br /> Phone: (cetl) �ilt- 2'iD. Offiyt� (office) tsZ, „?S� �'L-'ji <br /> Mailing Address: jJqp �Q (rbt ity:� ZIP:�� <br /> Contact Person: � t,. Applicant is: Contractor / Homeowner <br /> �Circle One) <br /> Email and/or Fax: � e�C.r�x�( ��L��(�r <br /> PROPERTY OWN JtNFORMATI0N:4 1 � von �bb � l. <br /> Name: �� <br /> Phone(day): <br /> Address: Cit : ZIP: s <br /> Email and/or Fax y�/��.. <br /> ARCHITECT/ NGINEER NFO MATION: <br /> IVarrie: t �,hJMtJ�.! �. l-3Zo- �-SCe�2.. <br /> Phone(day): <br /> i <br /> Address: 9Z�' JL►' •�.E. ��r� � City: �(�vL,O ziP: �S33Co <br /> Email and/or Fax: <br /> PROJECT INfORMATiON: Description of roject: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Suppiy <br /> ❑New Construction [�Single Family with ❑Accessory Bldg./Garage <br /> [S�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 ❑Storege <br /> MCWD review&permits. ❑Industrial ❑Warehouse ❑Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑OYher.(specify) ❑Othe�(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax 952�71-OFi82 <br /> www.m'nn <br /> Estimated Construction Valuation(exGuding land) ; �(�0�(��, �— <br /> Packet tast Updated:August 2015 <br /> Page 2f <br />