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t '� �����}���� � �, � , , <br /> l � � � � � <br /> � . � City of Orono �����_ <br /> Building Permit Application <br /> for New Structures or Additions <br /> MailiPO Bo�r66� Permit number. (,��U "'C����� <br /> �O�v0 Crystal Bay, MN 55323-0066 Date received: <br /> ti�l� <br /> Street Address:' ��.., ceived by: <br /> y� ,� `�� 2750 Kelley Parkway �p/(p --���� lan review fee: �" . � <br /> c.` � Orono, MN 55356 <br /> t�'�ES H��� Mai n: 952-249-4600 <br /> Fax: 952-249-4616 w�a��l..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: � S�c� Sl� ,��,� ��,�,�,, <br /> Will this be a Parade of Homes, Remodeler Showcase Home or other Display Home? ❑ Yes No <br /> If yes, a special event permit is required with Police Department and City Council approva/60 days prior to the event. Shutt/e bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: L�qo���s 8c�� L�� <br /> State License# Expiration Date: <br /> Phone: (cell) (o�� -_3��_33a1 (office) <br /> Mailing Address: •�- „�, Cit : ZIP: S�3 3 <br /> Contact Person: p��e,� UT��S Applicant is: act r Homeowner (Circle One) <br /> Email and/or Fax: �\�..Xp _�,��a,r,�, ,��,,�5 c.�,�.� <br /> PROPERTY OWNER WFORMATION: <br /> Name: A�Q <br /> Phone (day): (o� - <br /> Address: '-�110 1��"' r��� .So _ City: No,k:,�s ZIP: .5�3y <br /> Email and/or Fax G..\�� �-i',��„�. _��< �oo-. <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: (�.S;�k�s rRra:,��t <br /> Phone (daY): qS� -�y i -k(„�� <br /> Address: /S ,t.�;,,.�,,� �,,Q �n City: /���k,,,� ZIP' �5"S3y' <br /> Email and/or Fax: �r — �j�, e_ ��{�,� <br /> PROJECT INFORMATION: Description of project: =�-�-C�-tv ��/L �<<i�<�� <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) I��r�1�\ ❑ 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 <br /> ❑ 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 /> Estimated Construction Valuation (excluding land) $ o�D,o� , d� n���n�c� <br /> Packet Lasf Updated: August 2015 CITY OF ORONO <br /> Page 21 <br />