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� ' City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> MailiPgO Bd�d 6s6s: Permit number: Z���' -Z <br /> �O�Q Crystal Bay, MN 55323-0066 Date received: � � "—�tp <br /> Street Address:� Received by: � �� <br /> y � 2750 Kelley Parkw � �d� • <br /> �' c> Orono,MN 55356 C� - .-� Plan review fee: _�� <br /> .. _.__ ----- <br /> _ _ __--- <br /> �kfSHOQ'�` Main: 952-249-4600 Total ee: <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: ��p ���� /��� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> ff yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: , <br /> Name: R.��I.,.��..��,,.� I.�_„ � 5�„.,► e � <br /> State License# 5�,����� �� <br /> (�(,.,(d4-3a�_� Expiration bate: �/3t��-� <br /> Phone: (cell) c�12-�, S--r��g (office) �yS -���- � _ <br /> Mailing Address: � Ci : ZIP: - <br /> Contact Person: �„o,.., ���,,rQ,Y,-��Q � Applicant is: Contract / Homeowner (Circle One) <br /> Email and/or Fax: ��.,�„ ��������„`�,,�,o�,��`�� .� �N„ <br /> PROPERTY OWNER INFORMATION: <br /> Name: Ro1�„-}- IM;11 w <br /> Phone (day): �g��� �S_ ���� <br /> Address: �� SM:�^ �� City: d���� ZIP:�J� � ► <br /> Email and/or Fax ,�ol�.a-;,��,F,;��p ��e f,t,.4..��,��i L�� <br /> 1 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: g� /��� 4,: k�� < j��. �- 5}.oY 1.�.-�� <br /> Phone (day): ���, g,�p_c��a� <br /> Address: Ci :N ZIP: 5 <br /> Email and/or Fax: r����.r�\s s�^L��-, <br /> PROJECT INFORMATION: Descri tion of pro�ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8 <br /> Water Supply <br /> ❑ New Construction �Single Family with ❑Accessory Bldg./Garage <br /> �Addition attached garage ❑ Deck <br /> ❑Accesso Buildin � Public Sewer <br /> ry g ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation , detached garage � Residence ❑ Private Sewer <br /> �Other.(specify) �h...��� ❑Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> "*Any earth movement may require ❑Commercial ❑Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Othef:(specify) ❑Other(speCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952�71-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.o <br /> Estimated Construction Valuation (excluding land) $ -rjrjQ.pc� <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />