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� City of Orono <br /> � Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: �7�,`5 �G�� <br /> �Q A,O PO Box 66 Permit number: ��.� <br /> l V Crystal Bay, MN 55323-0066 Date received: �'�!-/ <br /> Street Address:' Received by: <br /> yF ,� 2750 Kelley Parkway ( Plan review fee: j J���� � , <br /> c,` Orono, MN 55356 \\ <br /> �qkFSH��`�` Main: 952-249-4600 o -Fg�-----__O�O�� ��9k'� <br /> — Fax: 952-249-4616 www.ci.orono.mn.us S Y f- �p�-�.� <br /> This application form must be completed in full and all required information mus itt�c�: <br /> Incomplete applications will be returned. (Please p � "�'� ��� ,��� <br /> GENERAL INFORMATION: 'v�s <br /> Job Site Address: / � � ��.i A-�2 ST . �RcNG � 1J ���9 � <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 ill b <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: � � <br /> Name: �, .,��, � ���\�.C' ��''L���5� �1-4-ri t�r'a�',�� �� � � i N� ��f A'�'v .� <br /> State License# �L P-� ' Expiration Date: �� -;�,� --o`�-�/(� ' <br /> Phone: cell .i ;z - � - L'`7 (office � +� <br /> Mailing Address: �(j 0('I-Y1 shore i7�. ��t��� ��o� _� -,:_•r, <br /> Contact Person: :..s � �;�, ;�\�o r 'J � �-�� e e��� Apl , /, . ' �'°�� one> <br /> Email and/or Fax: '.�', rn �,_, �vP �'� N �e v�`�,y f'' <br /> fr6r1� /"'• <br /> �.a,.i,�.�-- _..n... <br /> 'ROPERTY OWNER INFORMATION: `\ �.,.....��""'�' `""�' <br /> �Jame: �,Tc:t.�„�S � "C��\���r � 0'I'� <br /> Phone (day): (��;�.. - SS' �� — dL�c� � <br /> Address: /� � % �r- ; a f� �Q��'l'� w �1/ <br /> Email and/or Fax 1���� ���, � <br /> ARCHITECT/ ENGINEER INFORMATION: � <br /> Name: /� �33 ' , - <br /> �hone (day): �d - <br /> Address: <br /> Email and/or Fax: � __ _ <br /> PROJECT INFORMATION: Description of pro�ect: �p� VV�� <br /> 1. Type of Project 2. Proposed Use ���� 3 3g . I & <br /> [�,New Construction �ingle Family with <br /> C] Addition attached garage 1!, <br /> ❑ Accessory Building ❑ Single Fa gly 9th ��,�I'u � <br /> ❑ Relocation detached ara e 1 � � <br /> ❑ Other: (specify) ❑ Multiple Family/Condo <br /> ❑ Public ��""`� <br /> "*Any earth movement may require ❑ Commercial ��� <br /> MCWD review&permits. ❑ Industrial Z <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) � �r' •� <br /> 15320 Minnetonka Blvd ` <br /> Minnetonka, MN 55345 �� <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek or _ <br /> Estimated Construction Valuation (excluding land) $ ✓� ��� cGO, <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />