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City of Orono <br /> Building Permit Applicati <br /> for New Structures or Additions <br /> Mailing Address: Permit number: S^ <br /> PO Box 66 �9 2 _ <br /> 0 Crystal Bay,MN 55323-006$4� Date received: �—Io;3—�J <br /> Street Address:' Received by: �2 <br /> y V 2750 Kelley Parkway Plan review fee: _1U <br /> Orono,MN 55356 ��� <br /> kFSHOMain: 952-259-4600 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 /> Inemptete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: o�JKIL01 Dr .S6v fk <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: ar=E V-4 C,16 <br /> State License# );ic ro(P.3S 6q Expiration Date: 23/31 Qo/S <br /> Phone: (cell) I a-g So - s 9t l,o (office) 5;am c <br /> Mailing Address: o $0+y Ice N-441 City: A40tPt 1'ove ZIP: SS3/j <br /> Contact Person: Uerp Applicant is: (Contractor / Homeowner (Circle One) <br /> Email and/or Fax: 7TX g J'ConN V CoMccts .and <br /> PROPERTY OWNER INFORMATION: <br /> Name: Soh+v Srume))e <br /> Phone(day): i0i a -;a) - <br /> Address: SAS Willow 4ir City: Cyc4yo ZIP: <br /> Email and/or Fax 7Lhi yePa 6- Yahr�o• COM <br /> ARCHITECT/ENGINEERI�jFORMATION: <br /> Name: �t� f ;o".u., <br /> Phone(day): 763- 3 6 o <br /> Address: City: �auN ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion ofproject: <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 /> Addition attached garage ❑Deck Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage 7HResidence ❑Private 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 [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.org <br /> pp �7 <br /> Estimated Construction Valuation(excluding land) $ - q U/� Uva <br /> Packet Last Updated. January 2015 <br /> Page 20 <br />