Laserfiche WebLink
City of Or�ono � <br /> �t���dinc� Permit i4 iicatior� -�-��� � <br /> pp <br /> for �i�w �tructures or /�ddit��ns <br /> MailiPO Boxr66, Permit number: J(J/�'��� n? <br /> �0�� Crystal Bay, MN 55323-0066 Date received: � �J� -/ 7 <br /> StreetAddress:' Received by: /�/� <br /> y ,�' 2750 Kelley Parkway Plan review fee: <br /> �' L` Orono, MN 55356 • <br /> t�kESH��� Main: 952-249-4600 Total Fee: dU��'�0�5 <br /> Fax: 952-249-4616 tivv✓w.ci.orono.n��n.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: �CJ%C� �;�i�''�'�,;ti��� 6- �'✓ l,a/�=��//��; ��'�,�' ,;S�S� <br /> Will this be a Parade of Homes, Remodelers Showcas He o,me or other Display Home? ❑ Yes � No <br /> If yes, a specia/event permit is required with Police Deparfinent and City Council approval 60 days prior to the event. Shutt/e bus service will be <br /> required un/ess applicant demonstrates sufficient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR 1 APPLLCANT II�FORMATION: <br /> Name: ���I vr c% l5a j It�� <br /> State License# Expiration Date: <br /> Phone: cell � .;S (office) <br /> Mailing Address: /a tr�i' ��t/ Cit : ',�<,<��y'�t P: s S .� <br /> Contact Person: Applicant is: Contractor / omeow � (Circle One) <br /> Email and/or Fax: '" ��Z o/ � ,�, (�a�N�� � <br /> PROPERTY OWNER INFORMAT''! <br /> Name: ' '�� <br /> Phone (day): _ C� � � _ <br /> Address: �/.:; City. Z�P: <br /> Email and/or Fa � c <br /> ��,, i � <br /> ARCHITECT/ EN � �� �� <br /> Name: _ ( <br /> Phone (day): <br /> Address: _ City; Z�p: <br /> Email and/or Fax: <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Citv: ZIP� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <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 /> g y ❑ Office/Commercial <br /> ❑ Relocation �i detached garage ❑ Residence �Septic <br /> � Other: (specify) /lr�c� ❑ Multiple Family/Condo ❑ 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 <br /> ❑ 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.orq <br /> Estimated Construction Valuation (excluding land) $ l,�y pn� <br /> � <br /> Packet Last Updated: January 2016 <br /> Page 21 <br />