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Z R <br /> , , �� ���!.� <br /> CITY �F ORONO � ��Qb FEB � 7��(7 <br /> BUILDING PE MIT APPLICATION CI'nr oF oRONo <br /> FOR NEW STRUC URES OR ADDITIONS <br /> �Q A T Mailing Address: Permit number. c�L�I7- �O/l <br /> `VO PO BOx 66 <br /> Crystal Bay, MN 5323-0066 Date received: ��7'�� <br /> � ,, StreetAddress:' <br /> Received by: <br /> y� G.� 2750 Kelley Parkv�ay 1 0'�� Plan review fee: ��• 5 <br /> �9k�SH���C Orono, MN 55356 �1� o�j7-p p!�/ <br /> Main: 952-249-4600 , Total Fee: <br /> Fax: 952-249-4616 ' www.ci.orono.mn.us <br /> This application forrn`musf be completed in ull and ail required information must be submitted. <br /> Incomplete applications will be returned. (Please print) 5�;},Qs y�a�-y�lC <br /> GENERAL INFORMATION: , <br /> Job Site Address: y -}� - a SGG S ho..d, wcc_,� "�,. <br /> Will this be a Parade of Homes, Remodelers Showc�se Home or other Display Home? es No <br /> If yes,a special event permit is required with Police Department and Cit Council approval 60 days prior to the event. Shuttle bus service will be <br /> required un/ess applicant demonstrates su�cient on-site parking is avail b/e. Non-permitted events will not be a/lowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: <br /> State License# Expiration Date: ' <br /> Phone: cell (r,�� - - 3 � office <br /> Mailing Address: y�0 "' A��, � Cit : k,nz ZIP: ,j'3' <br /> Contact Person: R c - Applicant is: Contract / Homeowner (Circle One) <br /> Email and/or Fax: � - � <br /> PROPERTY OWNER INFORMATION: <br /> Name: l��cr�s 8c�I$ �. L.C . <br /> Phone(day): (�a_ 3�3 -3 3d 1 , <br /> Address: y �� 11''" .,. Cit : o , ZIP: sS y3 <br /> Email and/or Fax �.,\� �p �„„dk,���as ,,� <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: �.� -,,} s � <br /> Phone(day): ci�,� _ �y� _ g��,D <br /> Address: 1�1; }►. pp Cit : ZIP: <br /> Email and/or Fax: ;� f �,,� <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 Water Supply <br /> ❑ Single Family th ❑Accessory Bldg./Garage <br /> ❑Addition attached gara e ❑ Deck <br /> ❑Accessory Building ❑ Sin le Famil ith �Public Sewer <br /> g y �Office/Commercial <br /> ❑ Relocation detached gara e ❑ Residence ❑ Private Sewer <br /> �,Other:(specify) R�mn�� ❑ Multiple Family Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ,g(Public Water <br /> *`Any earth movement may atso 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 <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.mi nnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �C,j _ Qtg� , (�� <br /> Last Updated: January 2016 <br />