Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
� � City of Orono <br /> . �� �74.9 <br /> � Building Permit Application � <br /> i <br /> � for New Structures or Additions <br /> MailingAddress: Permitnumber: �/7- ��(� <br /> QA,. PO Box 66 <br /> � j VQ Crystal Bay, MN 55323-0066 \,` Date received: / -'��— <br /> Streef Address:' �� Received by: <br /> � ,�- 2750 Kelley Parkway � ��5 <br /> 9�, �, Plan review fee: <br /> c? Orono, MN 55356 <br /> �AkESH�4� Main: 952-249-4600 Total Fee: ��` �^�� � <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 /> JobSiteAddress: ' �OU r' � (,��-,,� � ����SrU� S�-3 �� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> lf yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service ill e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMqTl01�: <br /> Name: C_��'��Ir ��1C L Gl�/.�%�'��9 ���`j �/U� . <br /> State License# C '�r S l 7 7f- Expiration Date: �Zp j� <br /> Phone: cell �,f�-S �i�_ �, y�; '� office J�cr� -.�5 3 - ��_s��� � <br /> Mailing Address: 5,Z��` �S- ti /'�- Cit :/L `��zC�'� ZIP: —5_;j <br /> Contact Person: /�f� /« � ��L���/�t�t Applicant is: d�rt or� / Homeowner (Circle One) <br /> Email and/or Fax: /(,+�� �� �j t J�. L�jf-}�j�( ��;�1��,� y�tr»�S , C�i�1 <br /> PROPERTY OWNE INFORMAT� N: <br /> Name: � �' � Z`�' <br /> Phone (day): " ( (9�a - _ , - .�Cy <br /> Address: � ) ; Cit : ' ZIP: "3 j7� <br /> Email and/or Fax }� c�r.�ln C1 �'l�l /'lS i'.C <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: ��''uc� ��n.Y�i� � �vr'�l� �ee=fi 1 <br /> � Phone (day): � � S� <br /> Address: � O� � � �r- �cL. � K.,' Cit : .�' � ZIP: " ��2�} <br /> Email and/or Fax: ��•ty��,� ( L c�� �_���2 <br /> ARCHITECT/ ENGINEER INFOR TION: �C:�-ir`�-�� .�•;�G1 ,✓�;,'�I� <br /> Name: �itc� � e�: -� � /� - �. " l.c�� �- �In <br /> Phone (day): � �a - �{•�- • 4- <br /> Address: C� S• � Cit : � ZIP: � �t <br /> Email and/or Fax: �S,�L - S�� S r. ` <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8 <br /> � New Construction Water Supply <br /> � 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) ❑ Multiple Family/Condo 7] 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 � Public Water <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) ❑ Other(SpeCify) <br /> 15320 Minnetonka Blvd; Minnetonka,MN 55345 ❑ Private Well <br /> Phone: 952-471-0590 ! Fax: 952-471-0682 <br /> www.minnehahacreek.org <br /> Estimated Construction Valuation (excluding land) $ �(J�� Ot:�L! <br /> Packet Last Updated: January 2016 <br /> Page 21 <br />