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y� �S�'Y��1�..% �� 1 < J <br /> + /� v' �� ��(���.`.; p�-c^r�,�IC�Q..i'Y'�'C'��1 J 1 S(�'4Q <br /> ! ' ,l� Q <br /> � v <br /> CITY O�ORONO ��j� <br /> BUILDING PERMIT APPLICATION � �'�`�� <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O� MailiPO Bo�r66 . Permit number: :� ;i ' -] - � i ' � � <br /> �" � Crystal Bay, MN 55323-0066 Date received: � <br /> �i �, � Street Address:� _ -- `,F�e ceived by: � <br /> y� G� 2750 Kelley Parkway � � �,��� �� Plan review fee: � � , �� :}' <br /> C. <br /> !�'rf S H���. Orono, MN 55356 � ..__ __� � �'� C'!� � i�1�._ <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete appiications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 14��o G R l� Or-r o S�5 3 S�v <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> !f yes,a special event permit is required with Police Department and Ciry Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates suffrcient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: 1�/ Ae 5 st w� a5 a K-r,w— <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PFiOPERTY OWNER INFORMATION: 1 <br /> Name: Eri{r.w fsWlbrwr�Scr+ <br /> Phone(day): �p1'1 •3 0 9 • o I 1•} <br /> Address: a., Cit : r e ZIP: S�'3 <br /> Email andbr Fax G�Q y t4�w r, Sd� �t w+w��. Ge� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: N A <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> C'7� <br /> P�iOJECT INFORMATION: Descnption of pro�ect: ��,�% <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 ❑Private Sewer <br /> ❑Other: (specify) ❑Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑Public feet or greater ❑Public Water <br /> **Any earth movement may also require ❑Commercial �torage <br /> MCWD review&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 /> w�r�;r���i�nn�h,ahaaeeP:�:�^ <br /> Estimated Construction Valuation (excluding land) $ 5�Do0 <br /> Last Updated: January 2016 <br />