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City of Orono 3/ , V--5 <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> ��1 VO ��� PO Box 66 pi Permit number: p?O/7 De) SE` <br /> Crystal Bay, MN 55323-0066 i 1 Date received: --3-c7;7-1 7 <br /> \J 1t Street Address:' ` ' I�\'� Received by: f-�, <br /> � ,� "� 2750 Kelley Parkways �- /,✓ �j Plan review fee: <br /> �� Orono, MN 55356 l�' 11� <br /> t44-ESHo4* Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> .4 ,_,,,,,,,r,i) <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: 99L3 6c_9 1‘I A k44„ ," -G, ( <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes FLNo <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 I FORMATION: <br /> Name: - ,.v . a 0 - ' VIA-.3'f- 4--3/ -/ s'' <br /> State License # oZO Expiration Date: L.i.—31 -/ ' <br /> Phone: cell . - cf-2 - bcr-- office <br /> Mailing Address: 175-Ss S efr. b'-3 1Q City: : Cok,� ZIP: SS 3c ' <br /> Contact Person: f l/i ,c1. ,/ A plicant is: -. r / Homeowner (circle One) <br /> Email and/or Fax: inti 5-3-,3 g'7 e_ Ho , e ( <br /> PROPERTY OWNER INF RM "LN�� <br /> Name: 4 <br /> Phone (day): S3 4I h. / <br /> Address: t u--5 ti- )--k City:(Num ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: Y\ P LAD Der_ AL <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction <br /> 8-Single Family with 0 Accessory Bldg./Garage <br /> a-Addition attached garage (j-Deck <br /> ❑Accessory Building 0 Single Familywith El-Public Sewer <br /> 9 0Office/Commercial <br /> ❑ Relocation detached garage 0 Residence <br /> 0 Septic <br /> ❑ Other:(specify) <br /> 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 <br /> 0 Public Water <br /> Minnehaha Creek Watershed District(MCWD) 0 Other: (specify) 0 Other(specify) <br /> 15320 Minnetonka Blvd;Minnetonka,MN 55345 <br /> 0 Private Well <br /> Phone: 952-471-0590 / Fax: 952-471-0682 <br /> www.m i n n e h a h a creek.o rq <br /> Estimated Construction Valuation (excluding land) $ L, 'S ) <br /> Packet Last Updated: January 2016 <br /> Page 21 <br />