Laserfiche WebLink
i <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> q, PO Box 66 Permit number: Q/]-&V Q <br /> Crystal Bay, MN 55323-0066 Date received: X-%'/ <br /> Street Address:' Received by: -5f <br /> c <br /> y� 2750 Kelley Parkway Plan review fee: �:�✓• g0� <br /> c` Orono, MN 55356 _ <br /> `gkESHO�� Main: 952-249-4600 Total Fee: y T.16 <br /> Fax: 952-249-4616 www.ci.orono.mn.us 9AOo <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: 3WO W/LL eyiPp- S olac do, 5753s-& <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 INFORMATION: <br /> Name: MOIL- !7ot J /-7C <br /> State License# 15 coo I 1�j(P 0/ Expiration Date: 3 - <br /> Phone: (cell) &/2 . 5W• / 007 (office) J.$Z . '7(0 7. 7°1 yq <br /> Mailing Address: leo &A4Z- sr C Sol 4� Z City: WA ?,4-174 ZIP: SS 39 <br /> Contact Person: UNwe Applicant is: r / Homeowner (Circle One) <br /> Email and/or Fax: $L�}t1V(:. )GL-'>MP @ �rL -So,l. <br /> PROPERTY OWNER INFORMATION: <br /> Name: C-70#1fIA wl K LIZ MEIP��/ <br /> Phone (day): 6p/2 . Zp I. &q&(0 <br /> Address: .3-75-o +4VN77,-610 '�-4C City: $T7 &-J 1.5 t-09/4 ZIP: Ss W& _ <br /> Email and/or Fax w)E0i?y . C�IZ A•k'ivY1 I? C2✓Vs1/L• C'o <br /> I — <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �401z, -50 <br /> Phone(day): CQ(Z - 500. 16237 <br /> Address: 7&0 S,) (W Z/ City: tic-IR 6P4 77g ZIP: SSS/ <br /> Email and/or Fax: F3 LR► ILL-'rv+P� � - 5a,� • Co w� <br /> PROJECT INFORMATION: Descri tion ofproject: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> Q'New Construction Single Family with El Accessory Bldg./Garage <br /> Addition attached garage ❑ Deck ❑Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage ® Residence Zprivate 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 EKPrivate Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other: (specify) ❑Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952471-0590 <br /> Fax: 952471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation`(excluCl V in� $ �5�, Goo <br /> Packit Last Updated: August 2015 AUG 0 92011 <br /> Page 21 <br /> CITY OF ONO <br />