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r , � �� <br /> , � City of Orono � �(p � <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: � <br /> (� PO Box 66 Permit number: ��L J� O/� <br /> ���� Crystal Bay, MN 55323-0066 Date received: ��-.3 '/ <br /> i` � <br /> j � Street Address:' / Received by: �� <br /> �y ,� , 2750 Kelley Parkway ��► �� Plan review fee: �- .3�. 'J`- <br /> �' c,` Orono, MN 55356 ��'� <br /> �'�kesN��`ti Main: 952-249-4600 Total Fee: . �::� �d 5-�� � <br /> Fax: 952-24914616 www.ci.orono.mn.us (;.SGY �' ` <br /> This apptication form must be compteted in futt ard att required information must be subm ed. �,�K, <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION• , <br /> Job Site Address: � 7 c7 � <br /> Will this be a Parade of Homes, Remodelers S owcase Home or other Disptay Home? Yes No <br /> K yes,a special event permit is required with Police Department and City Counci/approva/60 days prior to the event. Shutt/e bus service wi be <br /> required unless applicant demonst2tes sufficient on-site parking is avallable. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPL, ANT FORMATION: <br /> Name: ���� <br /> State License# ,� Expiration Date: '3--3�' bC(L_ <br /> Phone: cell) - -�- , office <br /> Mailing Address: �Q( , ( r 1`�L� Cit : � � ZIP: 5� ,'�� <br /> Contact Person: Applicant is: ontractor Homeowner (Circle One) <br /> Email and/or Fax: - <br /> PROPERTY OWNER INFORMATI <br /> Name: S`�EyF � l ��� ,_��L� <br /> Phone (day): <br /> Address: LI�7's ��c��' a . ��ty: t�q� �I��ti Z1P: 55�� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER I OR ATION: <br /> Name: '� <br /> Phone(day): ' - � <br /> Address: L Cit : p ZIP: 5�, �t{ <br /> Email and/or Fax: <br /> PROJECT lNFORMATION' Descri tion of ro'ect: <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 �'beck ❑ Public Sewer <br /> Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage ❑Residence �"firivate Sewer <br /> ❑Other: (specify) ❑Muttiple Family/Condo ❑Retaining Wall(s) <br /> ❑ Pubtic 4-feet or greater ❑ Public Water <br /> *iMy earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review 8�permits. ❑ Industrial ❑Warehouse ,�Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other: (specify) (�Other(Specify� � <br /> 15320 Minnetonka BNd �r��„t rr;, <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ °������� <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />