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�.i�y ui vr�nv <br /> auua�ng rermii N►pp�ica�vn <br /> rvr ivew �uuciures vr Haa�t�ons <br /> - �( Meiling Address: �/...7 ` � � Z_ <br /> A.,'`� PO Bo�c 66 Parmit�umber. �� <br /> � O`Vt3� CrysWl Bay.MN 553230066 Dafe received: ��`/�/�/ <br /> 1 � <br /> Street Ad�Bess' fieceived by: � <br /> 2750 Kelle Par <br /> `\� �' Orono,MNy5535& y` �J/�C��i�J Ptan review fee: �� , g� <br /> �x�s ri na� M ain: 952-249-4600 <br /> �`""'�'""`� Fax: 952-249-4616 www.a.orono.mn.us �� �� <br /> This appliption form must be completed in full and all required infortnation must be submitted. <br /> Incomplete applicatiw�s will be returned. (P/ease prirrtj <br /> GENERAL INFORMA710N: <br /> Job Site Address: 7Q0 7 e r'v�. <br /> Will thls be a Parade of omes, Remodelers Showcase Home w other Display Home? Yes No <br /> M yes,a special evenf permtls iequired wdh Po!!ce DepaRment and CityCoundlapp�ovel 60 days pnor to the event Shuftle bus servrce wi <br /> required unless appikgnt demonstrates sulficienf on-site parldng is aveilabfe. Non�s�mitted eveMs wlll not be elbn+ed. <br /> CONTRACTOR/APPIICANT INFORMA710N: <br /> Name: �[, <br /> State License# 03 xp�iratan Date: — —'Z� <br /> Phone: (cell 2 office <br /> Mailing Address: : �✓a ZIP: _ <br /> Contact Person: Applicant is: ontre / Homeowner �ct2ka»� <br /> Email and/or Fax: jv-�y�d� 6"y ��� �� <br /> P120PERTY OWNER INFORMAl10N: <br /> Name: __ .�J"wi:� �iCc+bS <br /> Phone(day): <br /> Address: f�60 .S/�o,-a_f.r�n �.— City: o`-o,�Cj ZIP�„��/ <br /> Email and/or Pax <br /> ARCHITECTI ENGINEER INFORMIATION: <br /> Name: cC, <br /> Phone(day): _ f� �p ., 9�$_ <br /> Address: . C� : � ZIP��S <br /> Email andlor Fax: � r- /y` �*.iCatC�,SG,r� C <br /> (/,, T1 �� <br /> PROJECTINFORMAl10N: Descritionof roed: �-f�� �C)-�.1.5�, <br /> 1.�+pe of Projed 2 Proposed Use 3.�ture lype 4.Se�wege Disposel& � <br /> Water Supply <br /> �New Construction Single Family wRh ❑Accessory Bldg./Gerage <br /> ❑Addtion attnched garege ❑peck ❑Public Sewer <br /> ❑Accessory 8uilding ❑ Sin�e Famify with ❑Office/Commerdal <br /> ❑Relocation detached�rege Residence ❑Private Sewer <br /> ❑ane��s��ry� ❑Mul�ple Femily!Condo ❑t�em����wa�i�s� <br /> ❑Public 4feet or greater ❑Public Water <br /> "Arry earth movement may re�ire ❑Commercial ❑Storege <br /> MCWD review&pertnits. ❑Industrial ❑Werehouse ❑Private Well <br /> Minnehaha Creefc Watershed District(RdCWD) �Q�pr(�g�j{y� �p�pr�yPe4�� <br /> 15320 Mmnetonka BWd <br /> Minnetonka,MN 55345 <br /> Phone�. 952-07i-0590 � <br /> Fax.- 952-471-0682 <br /> Estimated Construction Valuation(excluding land) s �'�QC�t� <br /> PaGcet Lest Updated�August 2015 <br /> Pege 21 <br />