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RECEIVED <br /> City of Orono AUG 01 2017 <br /> Building Permit Application <br /> for New Structures or Additions CITY OFORONO <br /> Mailing Address: Permit number: 97�p <br /> PO Box 66 <br /> Crystal Bay, MN 553 3-0066 Date received: <br /> Street Address:' 7T Received by: <br /> y 2750 Kelley Parkway �c 9 !•" Plan review fee: <br /> F c> Orono, MN 55356 l <br /> `gkfSHO 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 sllhrni+'-" <br /> Incomplete applications will be returned. (Please prin <br /> GENERAL INFORMATION: Y�Iezt <br /> Job Site Address: 3z(PS '5~%-f6joop di mcug- C%� - <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display He �Q <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the e C/c� <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be a <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: r_1•Ibl&LIC'S %uOh Co. L-L-.(-. <br /> State License# gc G 3F, -2 #-S Expiration 7,o1q <br /> Phone: (cell) -17 - �qp- 7 l4w7 (office) <br /> Mailing Address: p " p City: PLN r%QLJ7V ZIP: 55"44-7 <br /> Contact Person: Sjt3dE Lo ebT Applicant is: on rac or / Homeowner (circle one) <br /> Email and/or Fax: SLi c1+T'e L;1d-p.r4Lg:SGu17p , Cam <br /> PROPERTY OWNER INFORMATION: <br /> Name: C,"MLk—S 4-1400 CO- L L. Com, <br /> Phone (day): (01j_ - 35-!7- /7O 9 <br /> Address: 1512 .SO Z 3, RO A-ye. N• City: (71_NiMp u ZIP: 5'5447 <br /> Email and/or Fax SL i rn4r 4e C4A.RI.ES CW Qtp . ! all <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: Loop C.o , L. L.0 . <br /> Phone(day): (P 12- - 3 S�j- /70-9-- <br /> Address: <br /> 09Address: I gys--d Z.3 A 1yE'. (,J . City: 17L\- ynauY1A ZIP: 55447 <br /> Email and/or Fax: 5 L W_W4- C2C (L� [-udp _ e4m <br /> PROJECT INFORMATION: Descri tion 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 <br /> El Bldg./Garage <br /> Addition attached garage ❑ Deck )4 Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other: (specify) ❑ 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 <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ '51, 4-0 0 9Q <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />