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..r. <br /> � � ,3g SEP 2 4 2015 <br /> - � �� <br /> C i ty of O ro n o ( ��-�pF ORONO <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: -, -- - - - � <br /> Permit number: ��' :"-`i • %� � <br /> A, PO Box 66 f ��� ' � <br /> �O`v0 Crystal Bay, MN 55323-0066 / Date received: `�—a —�_`� <br /> StreetAddress:' I �7 Received by: � <br /> � ,� 2750 Kelley Parkway ��` � �� �i' <br /> yF Plan review fee: <br /> c,` Orono, MN 55356 � <br /> �'�kFSHo��" Main: 952-249-4600 Total Fee: -���, .:�� `/l`�`�, i <br /> Fax: 952-249-4616 w�r✓w.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. �/l�plp PJ'U� <br /> Incomplete applications will be returned. (Please print) (j��+rLC'd.. <br /> GENERAL INFORMATION: � <br /> Job Site Address: � � � IJrj� ��; <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �,No <br /> lf yes, a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service w�ll be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: S:�N'!M;'f" Cf' L�(i <br /> State License# O � Z Expiration Date: - 3j•-/7 <br /> Phone: cell � Z office j� z y� - <br /> Mailing Address: , Z Cit : S' rti ZIP: 3�7 <br /> Contact Person: Applicant is: ontrac Homeowner (Circle One) <br /> Email and/or Fax: � rv� " • ` ,, ' � <br /> PROPERTY OWNER INFORMATION: <br /> ►vame: ,,P� •t- i Z;�z��� <br /> ry Phone (day): 952 Z � - <br /> � Address: , Cit : � � ` �` ZIP: ,�:j ' <br /> Email and/or Fax � p�}�1� �� iM 2 ci Z ;�h� <br /> J <br /> ARCHITECT/ ENGI EER INFORMA N: , <br /> Name: (,= 5 Q , <br /> Phone (day): q5Z � - O <br /> Address: 3 �'S F�rnr�;fi��r C'}. ���0 City: � �rv�SV i ��� ZIP: 55��7 <br /> Email and/or Fax: �ct,f0l��A� �.��P�I�!1 . GO�'►'1 <br /> PROJECT INFORMATION: Description of pro�ect: � � � C�"i� Q�,J Si "'�('_-��t� �S�d�_ <br /> 1. Type of Project 2. Proposed Use 3. Structure Type . Sewage Disposal 8� <br /> Water Supply <br /> w 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 f�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& 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.or <br /> Estimated Construction Valuation (excluding land) $ � V U, �Q <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />