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� <br /> ' � � City of Orono �1, 5g <br /> . . . . . � yl � <br /> Buildin Permit A lication � <br /> J pp � <br /> for New Structures or Additions <br /> Mailing Address: Permit number: /3=B' <br /> .�Q A>O PO Box 66 _ <br /> `w Crystal Bay, MN 55323-0066 Date received: — � <br /> StreetAddress:' Received by: <br /> ,��, ,� 2750 Kelley Parkway Plan review fee: 7�� � <br /> �' c,� Orono, MN 55356 ,, J <br /> tqkFSH04�' Main: 952-249-4600 Total Fee: ��� 's—D��J'�d� <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. (P/ease prinf) <br /> GENERAL INFORMATION: <br /> Job Site Address: /�j 0 0 �a Ldt.�R �Gi R-K f�04� . ��.D N� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other isplay 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: f�S'KDr�nes //� <br /> State License# gC,�?,� S"'q 2,, Expiration Date: , �, aC�_ 2�O1,6 <br /> Phone: cell 2 office <br /> Mailing Address: D ' c Cit ZIP: S � <br /> , Contact Person: P���� ,�(�p`g�q Applicant is: ontr ctor / Homeowner (Circle One) <br /> . Email and/or Fax: � Q � �L . �O <br /> i PROPERTY OWNER I MATION: I�J ��$�� � �I,t.0m <br /> Name: _�'f e�,/Q r'yL.Li o'�t <br /> Phone(day): Z � <br /> Address: L�,p O A�ciLd�12 �tQ�C �04� City: ��.0 R`�� ZIP: <br /> Email and/or Fax ,��/%07T.c�t! L j��70�leN . cor» <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: '�.L L G <br /> Phone(day): p <br /> Address: Cit : ZIP: <br /> Email and/or Fax: T a �'U� �/1 PilM6t h� G�M <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of ProJect 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8 <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 � Residence ❑ 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 8�permlts. ❑ 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.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) � ���* �Q� �� <br /> Packet Last Updated.• August 2015 <br /> Page 21 <br />