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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: a(7/7-d'357 <br /> 0A, PO Box 66 <br /> !VD Crystal Bay, MN 55323-0066 Date received: Zi---/3—/7 <br /> Street Address:' Received by: 6/14 N il/t F <br /> . ,* 2750 Kelley Parkway ('K l ,f f � )� 7—Dv��� <br /> Plan review lee: ' <br /> �� c? Orono, MN 55356 --___ _—__ <br /> 4kESH04� 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. �'`i <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION:. ,(J,,,� I <br /> Job Site Address: d - P U 1z 5 (: A 1 1--- ` t f„r 7,/ <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? 0 Yes o /2 <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 e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: iDtJ t_ ) 11,-.PRS L-L (. <br /> State License # 13G. Ce 3 `�Co Expiration Date: <br /> Phone: cell)C(012-) ',010 •`,a1-.-- (office) <br /> Mailing Address: CO. 1-Q A i Pi<ii- City: * file ZIP: •5070 <br /> Contact Person: \/ ' Applicant is: ontracfor / Homeowner (Circle one) <br /> Email and/or Fax: .11,..'Rv 11,.9 EI2..S ►Vi 0 yg4co,co M <br /> PROPERTY OWNER INFORMATION: // <br /> Name: MA1—T !rt13 ec A.I,3 A C. R-- 12---- <br /> Phone (day): M L'/.0 <br /> Address: MeV VO ll--MALfk''"T -C--41-1 i-- City: ZIP: 55 * <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> 'r 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: --(-_f Ct G- ` C1 LJ C C C <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> ❑ New Construction fSin Ie FamilywithWater Supply <br /> g ❑Accessory Bldg./Garage <br /> ❑Addition attached garage Weck 0 Public Sewer <br /> ❑Accessory Building 0 Single Family with 0 Office/Commercial <br /> elocation detached garage 0 Residence <br /> Other:(specify) ❑ Septic <br /> ❑ Multiple Family/Condo ❑ Retaining Walls) (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 55345 0 Private Well <br /> Phone: 952-471-0590 / Fax: 952-471-0682 <br /> www.minnehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ i'I I , q 70 GC <br /> Packet Last Updated: January 2016 <br /> Page 21 <br />