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� r A <br /> City of Orono �'�� �// 7 85 <br /> r I`' <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: _?d/S--C�/� � <br /> �A, PO Box 66 <br /> � `VQ Crystal Bay, MN 55323-0066 Date received: /v -a 7- /S <br /> Street Address:' Received by: i[ � /�/Ifi <br /> 2750 Kelle Parkwa <br /> y�" c,� Orono, MN 55356 Y Plan review fee: / `� 7��� <br /> `�kfSH��� Main: 952-249-4600 Total Fee: d��S v/ 3 �/ <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. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � 02� 7 CC�.SC� C►��''L�e <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> If yes, a specia/event permit is required with Police Department and City Council approva160 days prior to the event. Shutt/e bus service will be <br /> required unless applicant demonstrates sufficrent on-site parking is availab/e. Non permitted events will not be a/lowed. <br /> CONTRACTOR/APPLICAN INFORMATION: � , <br /> Name: So���r �'� ��Gl� .gt.c��c�P�+�'S L L� <br /> State License# G � ', Expiration Date: 3-3 1 - )-j <br /> Phone: cell Z - 44- �3'-7 o�ce IZ -� - $ <br /> Mailing Address: O p� �.D Cit : i c-�r � ZIP: S�g <br /> Contact Person: p_ p�qQ�r Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: __15 O rl �.��1 U M c�.i . �-o�'�► <br /> PROPERTY OWNER INFORMATION: <br /> Name: .�(� d- sa.,r'a.� S`�Y'�� <br /> Phone(day): S2-ZZ —�SZ � 3 g U <br /> Address: 3$6Z o r ern En u.� Ci' � .�;� �t� � . \ � <br /> Email and/or Fax �-�u.c�< 5S 84 �na� • �m � G ���� ��� � <br /> � � <br /> ARCHITECT/ENGINEER INFORMATION:� LV�`';_,�`" <br /> Name: {�c.`-F-i.c.,w►.� ��5, r7 � <br /> Phone(day): 4SZ- 73- / <br /> Address: I ��zz t,� h; e �; / �,�,� c�ty:l�e/%�/ai��ziP: � � b/ � <br /> Email and/or Fax: G�Lx� eS c• ro�+;e r n� . n�- <br /> PROJECT INFORMATION: Description of ro'ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> �$New Construction ❑ Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage 0 �eck ,�Public Sewer <br /> ❑Accessory Building � Single Family with ❑Office/Commercial <br /> ❑ Relocation eK�S`�'in� 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�permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Other: (Sp2Cify) ❑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) $ � `g �, 8�g <br /> � <br /> Packet Last Updated.� January 2015 <br /> Page 20 <br />