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City of Orono 70,3,3L <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: <br /> OPO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' Received by: '� <br /> 2750 Kelley Parkway Cj' Plan review fee: <br /> Orono, MN 55356 <br /> tgkESH04, Main: 952-249-4600 Total Fee: <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 su mitte . <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 1-/-7 V 0 70n��, �>���� 1 i� �r�r►o, M y, 5 536 <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 will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFOgMATION: <br /> Name: `57e✓e), V,,-.IPR <br /> State License# Expiration Date: <br /> Phone: cell / - -7 b office <br /> Mailing Address: 7-,:r, v .,, Ah City:Ut' ry ✓t ZIP: 6 <br /> Contact Person: e-_-,,, 1,1e, jr K Applicant is: Contractor / omeowner� (Circle One) <br /> Email and/or Fax: VCA I e-K 1 a M c; h ST7 - c.©✓K <br /> PROPERTY OWNER INFORMATION: <br /> Name: S eu C r V-'t I eK <br /> Phone (day): 12 - _)a d- :1 l ql <br /> Address: 7-z o T'o..?K c, t/; t'yv city: 9 r&P7 o ZIP: S�`L� <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: r v YVI <br /> Phone (day): v <br /> 2 5- <br /> Address: a rCity: ZIP: <br /> Email and/or Fax: h i ! b r II /�r:�c�cceh-7 <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction Single Family with ElAccessory Bldg./Garage <br /> UAddition attached garage ElDeck Public Sewer <br /> Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garageResidence ❑ Private Sewer <br /> El Other:(specify) El 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 /> �Q 15320 Minnetonka Blvd . <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> _q 1 RECEIVED -J <br /> Estimated Construction Valuation (excluding land) $ 3^, �''� 0e=p nDD I n 204.&--- <br /> Packet Last Updated: August 2015 CITY OF ORONO <br /> Page 21 <br />