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� City of Orono a ,�g <br /> Building Permit Application � 1 � � <br /> for New Structures or Additions ' <br /> Mailing Address: �> < <- :,� � <br /> �Q A,O PO Box 66 Permit number. L� (•� < < � .� <br /> f V Crystal Bay, MN 55323-006 \�\�� Date received: � `� �z —!J <br /> StreetAddress:� _ Receivedby;_ __ 1 ""{✓' I�--f <br /> � ,� 2750 Kelley Parkwa , Plan review fee: � � _ �� ` <br /> �' L` Orono, MN 55356 �� �����' �✓� / � <br /> !�'�fSHOR� Main: 952-259-4600 Total Fee: <br /> Fax: 952-249-4616 v✓��r.v.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. (P/ease print) <br /> GENERAL INFORMATION: <br /> .lob Site Address: ��p � �� C O �01 v� ��- <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�OR�VI�ION3�. 1 1 <br /> Name: u� uil�Q r'S <br /> State License# L-J� �O Z Expiration Date: 3-��- J$' <br /> Phone: cell ��/rj�fSZ� office �'j2-$$FS-2va <br /> Mailing Address: � 0 J Avvt.�5 . S- Cit : W� ZIP: � <br /> Contact Person: G i Applicant is: Contractor / omeowner (Circle One) <br /> Email and/or Fax: q WS c '�nC - C6 w� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��c✓y 1�J Q�. IMqP�UQ►'� <br /> Phone (day): <br /> Address: ZGo(� C43c o �p�v�-� ��� City: ��� o ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORM�4TION: <br /> Name: L-�ci.tc�tl� '�C I.���fC(S GLG <br /> Phone (day): i Z - G - �'o�S' <br /> Address: /`j�2 .�9� '�v �yvqGe, City: ��p�S • ZIP: S�{1!� <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 & <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�� � <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />