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• } ' <br /> � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: p� 5—D/ � <br /> �Q A, PO Box 66 <br /> / `VQ Crystal Bay, MN 55323-0066 Date received: //—U S-�5 <br /> � <br /> � StreetAddress:' Received by: <br /> �` 2750 Kelle Parkwa ' 3 � - � -- <br /> ti�, � Y Y � ���'�- Plan review fee: <br /> � �` Orono, MN 55356 � _ _ �� v � � �j <br /> `qkfSH� � Main: 952-249-4600 Total Fee: � <br /> Fax: 952-249-4616 www.ci.orono.mn.us � �� J `�� <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) f ; ,_;..♦. , ;�/,, j ; <br /> GENERAL INFORMATION: r <br /> Job Site Address: �� � � � / - � N'�/e w� S <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 us service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: � f.cl�.nlSv� -.n�c.�- <br /> State License# /�� (0;�7�j$ Z Expiration Date: � <br /> Phone: cell !g[Z- � S 3 5� office 7�,3. �{Z� -U 32.c <br /> Mailing Address: '3 � v ,K � Cit : e ��r� ZIP: �' 3 �[7 <br /> Contact Person: c.��T w N Su.�1 Applicant is: ontrac�r� meowner (Circle One) <br /> Email and/or Fax: �z,^-€-�o� r ��-- ��� <br /> S u h��s,.J -tv.�S. �aN� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ���� h-� /����.r� <br /> Phone(day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER ORMATION: <br /> Name: ��� lk-.-rN' � �- t r� <br /> Phone(day): fc 3 7 -v. <br /> Address: �; ,.��-� S �� �.cl� Cit : 1.h-c-r� ZIP: 55�� <br /> Email and/or Fax: � ,��p �' ��� <br /> PROJECT INFORMATION: Description 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 C] 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 <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ��� C.�iJ <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />