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City of Orono <br /> Building Permit A lication 1-/- 'i <br /> pp l <br /> q for New Structures or Additions <br /> V <br /> I,d' Mailing Address: / �D fi..� <br /> 0 ' 1' iztP PO Box 66 Permit number: <br /> 94 `VQ qi.,\,tri' d Crystal Bay, MN 55323-006uRECEIVEQDate received: M-1)/---/ <br /> 1 Street Address:' DEC 01 20166eceived by: P <br /> c,`'. <br /> ' 2750 Kelley Parkway St�� y, Plan review fee: YP i-f ?' <br /> Orono, MN 55356 CITY OF ORONO ) <br /> l'kEstiov- Main: 952-249-4600 Total Fee: oZd! ' ' ���S <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: 7,I0I,4.e WI, <br /> <-CA) Pair k(4)4 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ELNo <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/APPLJCANT INFORMATION: <br /> Name: �D K a 1 0 t-c S <br /> State License # YScl Expiration Date: <br /> Phone: (cell) j l') -7111- I©b (office) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Ef jar Applicant is: n acto - / Homeowner (Circle One) <br /> Email and/or Fax: e IC, se-I k ..5,011 y-eek hui'VE ; . (o wq_ <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: � � � 1 n l <br /> Name: b —e y i7L i/ <br /> Phone (day): / <br /> Address: ,___� `rt 9_ ZIP: <br /> Email and/or Fax: <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): e V/(4-0_ ---/4-4-e—,- / <br /> _ �� �// <br /> Address: / 14,14_ ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of, /I (11 <br /> 1.Type of Project 2. Prc 4. Sewage Disposal& <br /> Water Supply <br /> ew Construction ,,._ _ _ _ e <br /> ❑Addition attached garage U L., ,,„ <br /> ❑Accessory Building 0 Single Family with 0 Office/Commercial ❑ Public Sewer <br /> ❑ Relocation detached garage 0 ResidenceSeptic <br /> ❑ Other: (specify) 0 Multiple Family/Condo 0 Retaining Wall(s) (Compliance certificate <br /> 0 Public 4-feet or greater may be required) <br /> **Any earth movement may require 0 Commercial 0 Storage <br /> MCWD review&permits. 0 Industrial 0 Warehouse 0 Public Water <br /> Minnehaha Creek Watershed District(MCWD) 0 Other: (specify) 0 Other(specify) <br /> 15320 Minnetonka Blvd;Minnetonka,MN 55345D-Pnvate Well <br /> Phone: 952-471-0590 / Fax: 952-471-0682 <br /> www.minnehahacreek.oro <br /> Estimated Construction Valuation (excluding land) $ y � > iD <br /> Packet Last Updated: January 2016 <br /> Page 21 <br />