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. <br /> �' City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: ����J 3 <br /> QA,. PO Box 66 Permit number: <br /> � `v0 Crystal Bay, MN 55323-0066 Date received: � " �z �� <br /> StreetAddress:' Received b : 1 "'"{,1 � <br /> 2750 Kelley Parkwa <br /> ��' L` Orono, MN 55356 ��� �5`�� �✓'3 Plan review fee: � �.3 <br /> tq'�E S HO4� Main: 952-259-4600 T o t a l F e e: <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: 2�p `j CC CO �O�- ��- <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 will b <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT I�ORlVIVA�TION��. l� <br /> Name: us�u ui/ rS <br /> State License # G J� �/O Z Expiration Date: 3-$�- J$' <br /> Phone: cell -g/Q�fSZ� office 2�$$�-�va <br /> Mailing Address: � p awus . � Cit : ZIP: � <br /> Contact Person: < < Applicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: a wS c ' C • C6 w� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �v4 1�' J 4� IMQY'�Ua✓� <br /> Phone (day): <br /> Address: 2Got� C4'Co �,p�v�-� �� City: ��� o ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORM�4TION: r <br /> Name: �-tc Nc�tL� '�412 Lt i�C)s �C <br /> Phone (day): �Z - G - �o/s' <br /> Address: /`j�a �q ��yvqG� City: ��p�S • ZI P: Sj'r'L{I!� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <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 ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation 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&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) $ 2��� l�C� � <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />