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i <br /> � � , <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: � �_D �� <br /> �Q A> PO Box 66 1 � Permit number: � l <br /> `VQ Crystal Bay, MN 55323-0066• �A� �,� Date received: l l,j 1,,� <br /> Street Address:' ��a'y Received by: <br /> � ,� 2750 Kelley Parkway <br /> y�' c,` Orono, MN 55356 Plan review fee: <br /> `qkFSHO�� Main: 952-249-4600 Total Fee: �� 1 <br /> Fax: 952-249-4616 www.ci.orono.mn.us QS T"' ((�d, <br /> This application form must be completed in full and all required information m st be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address z-C��CJ '��� ��S , G'C <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service ill be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLIC NT INFORMATION: <br /> Name: �— �: � � e� .�ri° �� ��Si � ��� �LC <br /> , �,�, �,, <br /> State License# .,�'�G. ��X y Expiration Date: ,���j(� <br /> Phone: cell � . C>, office <br /> Mailing Address: ,S i '„ ;`, - / Cit : , (�i�, � ,�,�ZIP: ����/zG= � <br /> Contact Person: « /oF Applicant is: Contractoy / Homeowner �c��ae o�e� <br /> Email and/or Fax: �,�4.,/�,�'�,,>s�a, ��r.:�-, r�4X 1S-Z ����' f?G'90�j <br /> PROPERTY OWNER INFORAjIATION: <br /> Name: %���t {� G< ..�/cr�t1i G /`�/1SAs'/ <br /> Phone (day): f 5 Z S'�jc� �5�.� <br /> Address: zc,�C� �,��.f�s ,�v� City: ��-r•,�l�, ZIP: ��3�/ <br /> Email and/or Fax _ ���5�� ��N1�Y�,�� �`��r'� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: 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 8� <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 � �h /_ detached garage ❑ Residence ❑ Private Sewer <br /> [�Other: (specify) �1��r�C T�f�✓��1 ❑ 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) ❑ Other: (SpeCify) �Other(SpeCify) <br /> 15320 Minnetonka Blvd �'�j�/��-2u� �i!'rC� <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ .�L^� OC�C'J �f <br /> � <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />