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Y <br /> � City of Orono <br /> Building Permit Apptication <br /> for New Structures or Additions <br /> MailiPg�Bddre�ss: permit number: �� <br /> ��{'�+� Crystal Bay, MN 55323-0066 Date reoeived: j — 'Z—/ <br /> StreetAddress:' eceived by: <br /> y � 2750 Kelley Parkwa review fee: <br /> �' �` Orono, MN 55356 / Z `3 Q <br /> t�'��sHfl�`� Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-+4616 www.a.orono.mn.us <br /> This application form must be completed in full and all required information must be submii#ed. <br /> Incomplete applications will be returned, (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �2� �� � �OtiTl�-� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> If yes,a specia!event peimit is iequired with Police Department and City Council approval 60 days prior to the event. Shuttle 6us senrice will be <br /> required unless applicant demonstrates suffcient on-site paricing is available. Non-pemritted evenis will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: IrY1� 1�-�2 l�l.�C � ��Y�(ti�� . <br /> State License# G Expiration Date: <br /> Phone: cell - 2, - S3 office - Z - <br /> Mailing Address: Ci :k,a� n�- ,6� �P: <br /> Contact Person: Applicant is: ontracto / Homeowner (Clrcle One) <br /> Email and/or Fax: r"m h h�„�d e��i 1� @ a�a,i���,.,., <br /> PROPERTY OWNER INFORMATIO <br /> Name: �iz��j� ���l. �0� r,l <br /> Phone(day): C�'�Z-47fo -4-�75 <br /> Address: -�Ls�- �,�'- q.�,` ►J City: Z�p� <br /> Email and/or Fax -�-��('�y�,�h i(l J� C.[�r-� ��� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �1-�w�.S�T�rr.S r'U1'S '1���J�J��.�.c. � '�C.-( ,,S,S <br /> Phone(daY)� �-4�- �dZ- 39�1� <br /> Address: i!�p w p,��,.,y� � �W 1j �I� 1 City:'�.�rp�� ZI P: 2 I Z3 Q <br /> Email and/or Fax: /]j�eisp �, � �,�,.,,,}�,rs��sa r �� <br /> L <br /> I <br /> PROJECT INFORMATION: Descri tion of ro"ect: (.(�►nn-�fZ A�n>>�-(, �-►� •L� � <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> New Construction Water Supply <br /> ❑Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck <br /> ❑Accessory Building ❑ Sin le Famil with ❑Public Sewer <br /> ❑Relocation 9 Y ❑Office/Commercial <br /> detached garage ❑Residence �Private Sewer <br /> ❑Other: (specify) ❑Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑Public 4feet or greater ❑Pubtic Water <br /> *"Any earth movement may require ❑Commercial ❑Storage <br /> MCWD review&permits. ❑Industrial ❑Warehouse �Private Well <br /> Minnehaha Creek Watershed District(MCWD) �pther: (specify) (�Otht;f(Sp2Cify) <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) $ '7�Q ,�pD <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />