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City of Orono �l ��7 �� <br /> Building Permit Application <br /> for New Structures or Additions <br /> _ Mailing Address: Permit number: 0�5 ��/ <br /> c1 O/�� PO Box 66 Q <br /> y `Q Crystal Bay, MN 55323-0066 Date received: 7—�lS <br /> StreetAddress:' Received by: <br /> y� � 2750 Kelley Parkway Plan review fee: 7 J`_i%� <br /> c,` Orono, MN 55356 <br /> �"�KESNo��" Main: 952-249-4600 Total Fee: O` —D�� <br /> Fax: 952-249-4616 www.ci.orono.mn.us s � <br /> This application form must be completed in full and all required information must be subm ted. r�ItMtd✓ <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ��ir �; ,.,jr�� .� ,� � a ' <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes - No <br /> lf 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 su/ficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: /l/�'�e,� f,/.,..�.c 3 <br /> State License# 3� G 3`� :�� I Expiration Date: 3 - 3 l - �'J <br /> Phone: (cell) �i;t 3�G �. (office) <br /> Mailing Address: i'��,� 7 zj5� Av�. � City:Q/`�7h��� ZIP: �;��/��Q, <br /> Contact Person: G{,r�S /'1/r�✓}v�� Applicant is: !C�' / Homeowner (Circle One) <br /> Email and/or Fax: C;/�r��S/►1� /1 v�"��h /-l�'nc-c 3 : C:c��Y� _ <br /> PROPERTY OWNER INFORMATION� <br /> Name: �'�{y�(L <br /> Phone (day): �;��1, ' <br /> Address: j <br /> Email and/or Fax ��� <br /> �,�"f. <br /> � g 3 <br /> ARCHITECT/ENGINEER INFORMATION: � � <br /> � Name: j�,� �_ rJ�S��r� � � �j I <br /> Phone (day): �i�- S•j 7�'-1,�L q � <br /> Address: D ' <br /> Email and/or Fax: ���l�,l;� � t 7 �in sL1�41. u/ h��f�u�• � , c.� � _ <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use <br /> New Construction (�Single Family with � <br /> Addition attached garage [ <br /> ❑Accessory Building ❑ Single Family with [ <br /> ❑ Relocation detached garage [, <br /> ❑Other: (specify) ❑ Multiple Family/Condo ❑ <br /> ❑ Public ,J r'ublic Water <br /> **Any earth movement may require ❑Commercial ❑ : <br /> MCWD review&permits. ❑ Industrial ❑V _..:��ouse ❑ 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) $ �L�F �d(' <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />