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. � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> /�OA'� P��X� Permitnumber: ��IS� d /O p�J <br /> / `YQ\ Crystal Bay.MN 55323-0066 Date received: �_��,3--�-__-{ <br /> ' y �r Street Address:' .. Recerv �-- --�---—_"' __. <br /> � � � -- -- <br /> 2750 Kelley Parkway Plan review fee: � l 9_��-2� � <br /> Orono,MN 55356 ��j � v� � <br /> \�"4KesrroR/�� Main: 952-249-4600 �-.�� - �__ <br /> -------- Fax: 952-249-d616 __ ��o_� s���_S�__� <br /> This application form must be completed in full and all required information must be submitted. <br /> tncomplete 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 /> 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 /> 2quired unless applicant demonshates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLIC T INFORMAT ON• <br /> Name: ����� (��� ��L_ <br /> State License# � �f 2 GS -� -� Expirat n Date: 3 -S �T.e f� <br /> Phone: (cell) (ilL- Z�'D- Offi�/1� (office) LrZ -LS� �21L <br /> Mailing Address: pp �Q (rG� ity:�r� ZIP:/y�� _ <br /> Contact Person: �,Y Applicant is: Contractor / Homeowner �Circle One) <br /> Email and/or Fax: ��(�(�'!�:+w�C`.r��.l��( ���Li�L <br /> PROPERTY OWNER INFORMATION: • j /��,�,, <br /> Name: �� L. ! ��h �� � F•�1," <br /> Phone(day): City:j�pl�Tp ziP: SS3°I I <br /> Address: <br /> Email and/or Fax y�/�(2/�'f�}- <br /> ARCHITECT 1 NGINEER NFO MATION: ���� <br /> Name: � a t ML,I�.� � �-3Z�- �xs'f-S(��2-. <br /> Phone(day): �3�$� .�;'y�"' <br /> Address: q1q �ru � E', ���p �/ City: �[p ZIP: �S'$3(p <br /> Email and/or Fax: T <br /> PROJECT INFORMATION: Description of project: ����"�� f��� ���f��� <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage isposal& <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 8 permits. ❑Industrial ❑Warehouse ❑Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Othec(speCify) ❑Other(specify) <br /> 15320 Minnetonka BNd <br /> Minnetonka.MN 55345 <br /> Phone�. 952-471-0590 <br /> Fax. 952-471-0682 <br /> www.minn h re ..er <br /> Estimated Construction Valuation(excluding land) ; '���i(��, �- <br /> Packef Lasf Updated: August 2015 <br /> Page 21 <br />