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Cit aJ <br /> y of Orono ao7, � <br /> Building Permit Application t �) <br /> for New Structures or Additions <br /> Mailing Address: Permit number: 1 '� (c <br /> PO Box 66 <br /> VQ Crystal Bay, MN 55323-0066 Date received: -7—)/ <br /> Street Address:' b <br /> 2750 Kelle Par a <br /> 4� y y �(,, -(�vc3 Plan review fee: �I J <br /> c? Orono, MN 5535 <br /> `1kESHOSE 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 submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERJ NFORMATION: <br /> Job Site /- 4-�., <br /> Will this be _ . le of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes,a special even ; rmit 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 INFO MATION: 1 <br /> Name: J Ir` Ylrl�-S At An-f_ L. <br /> State License# Expiration Date: ZO I <br /> Phone: cell (Q office 3• `IS Ob <br /> Mailing Address: a , 1Q_ Cit : ZIP: __ <br /> Contact Person: Applicant is: Contra / Homeowner (Circle One) <br /> Email and/or Fax: 61 krk , C.QYK <br /> PROPERTY OWNER INFORMATION: <br /> Name: 1,VI-P L"4- 414 Cpvc0 r© <br /> r Phone (day): 6�I a -`jam(-`j - ins(pa <br /> Address: City: ZIP: <br /> Email and/or Fax M�,K_ r 5 —1 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: ( Q S&-7 c��l C��ry►r� <br /> Phone(day): - <br /> Address: O �i�t�1 Q S X::41 t$ City: (C"ykP ZIP: 55A!71-_.9? <br /> Email and/or Fax: Lh —c*) 'h�'�n�c��g n (n)nq <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 Familywith Accessory ry 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 ❑ 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 /> c?c+ <br /> Estimated Construction Valuation (excluding land) $ �J 55, c� <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />