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- r City of Orono <br /> , <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �� " 0 ���j <br /> Q�T PO Box 66 �� — <br /> � `V� Crystal Bay, MN 55323-0066 Date received: <br /> StreetAddress:' Received by: � <br /> ,� 2750 Kelley Parkway 5C13� <br /> y�' �` Orono, MN 55356 Plan review fee: <br /> !q'rfSH��� Main: 952-249-4600 Total Fee: aD 1 7 — � <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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ����"j �����t�,�y�" � ����/�'���- �,u S�;�( <br /> Will this be a Parade of Homes, Remodelers Sf�wcas Hoe me or other Display Home? ❑ Yes � No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the evenf. 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: , G, I <br /> Name: v -�. ,— ��-z.���"� Jl �. ff.��� <br /> State License# 9 Expiration Date: Z. <br /> Phone: (ce11)('v/� —7y3-- ���' (office) <br /> Mailing Address: iUa� � � '� Cit : G'ti.�-> m ZIP: 3 � <br /> Contact Person: P��,� Sj�,v#-�;,,� Applicant is: ontractor� / Homeowner (Circle One) <br /> Email and/or Fax: w�.� d b� v�.r e�t c� 12•� z�� , c.o�-�-� <br /> PROPERTY OWNER INFORMATION: L��� �� ��Tr ` � � $�3i� <br /> Name: ��IC 11 ' � 1— (�;�"'�'�V 1 — <br /> 21_0 � <br /> Phone (day): rv J•—3a?-- $o <br /> Address: h �,.�o-a �'� Cit :�.C�%�-� ZIP: SS3� <br /> Emailand/orFax t�v�����y�L(„�� c,hSi-��� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: �o�s Wl��i(c� <br /> Phone (day): . .�_,� __ ' ��- <br /> Address: 3 5 3 ( 3� ��. � Cit : �C,)^ ZIP: 3� $ <br /> Email and/or Fax: hrY��'h h� �J��y,Z��-t <br /> ARCHITECT/ ENGINEER INFORMATION: ( _ <br /> Name: �r��L� �- • �V oP e�l'��-�,+..�. <br /> Phone (day): c �2�— �( — , 0�3 � <br /> Address: � �f O o c � r� Cit :�v��r i',��-� {y�IP: ���'�. <br /> Email and/or Fax: _ p-��ter� � c.n� �cvnc��ti�t.;�. <br /> PROJECT INFORMATION: Description of project: <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 ❑ Septic <br /> ❑ Other: (specify) ❑ Muttiple Family/Condo ❑ Retaining Wall(s) (Compliance certificate <br /> ❑ Public 4-feet or greater may be required) <br /> *`Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse <br /> ❑ Public Water <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other.(speCify) ❑ Other(speCify) <br /> 15320 Minnetonka Blvd; Minnetonka,MN 55345 � �������EQ <br /> Phone: 952-471-0590 / Fax: 952-471-0682 <br /> www.minnehahacreek.orq LU�, <br /> I. ,i <br /> Estimated Construction Valuation (excluding land) $ '7�, p�O ��` � � <br /> Packet Last Updated: January 2016 <br /> Page 21 C1T`(OF ORONO <br />