Laserfiche WebLink
CP�, ,q �I ( <br /> City of Orono - � <br /> Building Permit Application <br /> for New Structures or Additions p <br /> Mailing Address: Permit number: <br /> 0PO Box 66 <br /> o Crystal Bay, MN 55323-0066 Date received: - <br /> f <br /> Street Address:' <br /> Received b y Seo d G <br /> o`i 2750 Kelley Parkway Plan review fee: <br /> \tag, og� Orono, MN 55356 <br /> \;Ess,� -nelpy <br /> _--- <br /> - Total Fee: 5 qO(o..7.5- <br /> Main: 952-249-4600 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: 315 7-oniKaWa_ Road , Orono Hd 55,35'(0 <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 sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: jellS.Q1> F 4 o 0-)e S T.nC <br /> State License# // Expiration Date: 3-31-/5 <br /> Phone: 9 5 - `{-�►S -0'5+g' (office) (cell) <br /> Mailing Address: OI CGt.r 1 or i 1 as City: inna KA- ZIP: .5S,30.5 <br /> Contact Person: Ra4nd-y gad,02/Q 0Applicant is: ontractor Homeowner (circle one) <br /> Email and/or Fax: rar+d�t fenser,ho►rtie s. COm <br /> PROPERTY OWNER INFORMATION: <br /> Name: Mow ha_ Intl C 1V;//ari <br /> Phone(day): 9.5.l - 473- S(o73 <br /> Address: 3/5 7_,0rnA,14tAc>a- AdQoL City: arOr)O ZIP: 5-5 3 540 <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: RiL/C SDS _,4-C,6jAL+�5 <br /> Phone(day): &/.,� - 9/0 - 9G k <br /> Address: /o /3 5 '`f 7Y'h AL)e- City:/0/Vi'"0Uy-0(-) ZIP: 5,5rVi4;z1 <br /> Email and/or Fax: <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ElNew Construction XSingle Family with Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> �-Other: (specify) F+n+bh'^9 eXrS'A El Multiple Family/Condo [I Warehouse <br /> J� 6 Gee. ❑ Public El Storage El Public Water <br /> Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minn h h creek.orn <br /> Estimated Construction Valuation (excluding land) $ 75- 000 <br />