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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> PO Box 66 Permit number: 2— 01 - <br /> V Crystal Bay, MN 55323-0066 Date received: 5 - 1 -]-� <br /> Street Address:' by: <br /> a ' 2750 Kelley Par a h <br /> sF y y �(p -(�bvc Plan review fee: G �J <br /> c` Orono,MN 5535 <br /> ESHo�� 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 /> GENERAL INFORMATION: <br /> Job Site Address: 2, jcc�_A <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 INF MATION: <br /> Name: r` rrp L <br /> State License# Expiration Date: ZO <br /> Phone: cell (Q office 3• "75 Ob <br /> Mailing Address: a r Cit : ZIP: <br /> Contact Person: Applicant is: Contra / Homeowner (Circle One) <br /> Email and/or Fax: 6l ; • C <br /> PROPERTY OWNER INFORMATION: , l I <br /> Name: 1- r0 t7�, rc)t7 <br /> Phone(day): GO I <br /> Address: City: ZIP: <br /> Email and/or Fax t"1�,4_ C4 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: y f Q nyq SW t, A~1 <br /> Phone(day): <br /> Address: tL CS1 0 K City: �0-kyl.Q ZIP: 5511 <br /> Email and/or Fax: ih��'� ��7plZ ,Ac„ag n /tail- <br /> PROJECT INFORMATION: Descri tion of project: NUJ ,, <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> New Construction Single Family with [IAccessory 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 /> 00 <br /> Estimated Construction Valuation(excluding land) $ d 000 "'- <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />