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T � <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions ,2 G <br /> AA.. Mailing Address: \\ Permit number: v)0/ <br /> Crystal Bay, MN 55323-0066 '\ Date received: /A <br /> Street Address:' � 6 Received by: <br /> A �. 2750 Kelley Parkway �� Plan review fee: <br /> Orono, MN 55356 0�0/ S �_ <br /> � <br /> °tesnoa� 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: Z7o(`r' <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ,RNo <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 INFORMATION: <br /> Name: L K) v--Yt"Z- <br /> State License# y i Z Expiration Date: <br /> Phone: cell — Su office <br /> Mailing Address: / 6 L Cit : C ZIP: _-03- <br /> Contact Person: U Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �1 <br /> Phone (day): ly ZI <br /> Address: 'Z7o 9 1,41Ajf r LL City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINgR INFORMATION: <br /> Name: 6AU 1441 tAs <br /> Phone(day): Z_3 +�- <br /> Address: ;/t�t �2 City: ;/Yt ZIP: 53 / <br /> Email and/or Fax: C-04 AtL- - c�,i:mvs� <br /> PROJECT INFORMATION: Descri tion of ro'ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑Accessory Bldg./Garage <br /> ,gaAddition attached garage El Deck <br /> El Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other: (specify) [:1 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 E]Warehouse <br /> 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) $ 7S�06k 04— RECEIVED <br /> DEC 01 YU11 <br /> Packet Last Updated: August 2015 <br /> Page 21 <br /> CITY OF ORONO <br />