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� . �ity af Orano � . Building Permit Application fer New Structures or Additions Mailing Address: ��n��r.._ Q PO Box 66 Permit number: � ` � "1 � �Q Crystal Bay, MN 55323-0066 Date received: L3 I�S StreetAddress:' ,�--"��, Received by: � � 2750 Kelle Parkwa � � "`��—"" � �. � Y Y Zt�l 5 (,`�(-33 Plan review fee: � � • ��J �' c? Orono, MN 55356 � ___ �__�___ ____ � `�kFSH�4� Main: 952-259-4600 Total Fee: i Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: J�(�(� �1.�� %�� (��-��,� /L1lV �S3�y Will this be a Parade of Homes, Remodelers howcase Home or other Display Home? ❑ Yes f�No If yes,a special event permit is required with Police Department and City Council approva160 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPLICANT INFORMATION: Name: e�c��l ''o��•,� F? �e��.ex� ,.�r L LC State License# Z Expiration Date: Phone: (cell) �/z-3��-y��-- (office) ��er Mailing Address: y/3a S,: rL(c;r,� �r;,.� Cit : �;H�a,.�k� ZIP: S Contact Person: 5��*+ J"oi,�ri�:�-� Applicant is: ontractor / Homeowner (CircleOne) Email and/or Fax: _S�Go-E-�� c�c�cP;lc.�kU�,e.s. �`� PROPERTY OWNER INFORMATION: Name: Dc��.,. To•tw.a,,� Phone (day): �S�- �/S/-�2 9 7 Address: 13�ob Gl�erv��i �lw�� City: C�rc�-�c� ZIP: �S�lvS/ Email and/or Fax �-}-��l-w,u�v, ��k S'c�..✓�✓;c�.s., Go�-� ARCHITECT 1 ENGINEER INFORMATION: Name: �.DS �r�1,�;-}-�c1�s Phone (day): �i�-�?/p -`i(c Z� �/ Address: yqoD f-1�tii1,,�,�2 , f6`1 5�.��fe��0� CitY: �ei,vH�o�Ot, ZIP:,jSy� Email and/or Fax: 7l�3;ss c_ �5� PROJECT INFORMATION: Description of project: C��` � �''�� .-i°��'�� e�� 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& Water Supply ❑ New Construction �Single Family with $]Accessory Bldg./Garage �Addition attached garage �Deck � Public Sewer ❑Accessory Building ❑ Single Family with [�Office/Commercial ❑ Relocation detached garage Residence ❑ Private Sewer ❑ Other: (specify) ❑ Multiple Family/Condo � Retaining Wall(s) ❑ Public 4-feet or greater �Public Water **Any earth movement may require ❑ Commercial ❑Storage MCWD review&permits. ❑ Industrial ❑Warehouse � Private Well Minnehaha Creek Watershed District(MCWD) ❑ Other:(speCify) ❑ Other(SpeCify) 15320 Minnetonka Blvd Minnetonka,MN 55345 Phone: 952-471-0590 Fax: 952-471-0682 www.m i n nehahacreek.or Estimated Construction Valuation (excluding land) $ 7��L� Q�-c e Packet Last Updated: January 2015 Page 20