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. � City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> MailingAddress: Permitnumber: ��C�S"� � "l <br /> ��A,O PO Box 66 <br /> `V C stal Ba MN 55323-0066 / <br /> rY Y� Date received: Z3 I S <br /> Street Address:' —- �• Received by: /� <br /> y � 2750 Kelley Parkway j Z.(;�5 -(,�(,133 Plan reviewfee: � � - �J� '�b� <br /> �' c,` Orono, MN 55356 �_ <br /> �q �� .__ _._. _ _.—f. �.; -:�� <br /> kFsxo Main: 952-259-4600 Total Fees: �` � �� � `- <br /> Fax: 952-249-4616 �.���-���-��.ci.c�rono.mn.us �- <br /> This application form must be completed in full and all required information must be submit d. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: - �� (�` /Ul� 5`5.��>y <br /> ���.;�� �1�.�✓ ^y ��C_�_� .��' .��� <br /> Will this be a Parade of Homes, Remodelers howcase Home or other Display Home? ❑ Yes �No <br /> If yes,a specia!event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: /' <br /> Name: �-�d�%�c�., c ,,r. � �r��n�rY- ,.nc L 1.-C <br /> State License# Z Expiration Date: <br /> Phone: (cell) �/Z-38� - �/!(vS" (office) S�:.�� <br /> Mailing Address: -'-f/ ;� ST, /1�ic;�k �-;�� Cit : 7�.,���ti�k�, ZIP: .SS,;c�S-- <br /> Contact Person: s��*+ Sai,.K�:..-� Applicant is: ontractor / Homeowner (CircleOne) <br /> Email and/or Fax: .5���tt� c�c��Q,lc.v h�.'�s, ���� <br /> PROPERTY OWNER INFORMATION: <br /> Name: �,.�.._ Tc rw.a.,.�. <br /> Phone (day): �SZ- �/-S i-�Z 97 <br /> Address: 1..��vb C-j'Ie rN�i �i�.�� City: C:�-�:�c, ZIP: .$S s�y <br /> Email and/or Fax �}�t,.�,�L�N " c,k S'�.Y^�.«s . � ��� <br /> , <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �.1�5 �r�..l,�,t��S <br /> Phone (day): �i 2 -��C -`iG�Z� <br /> Address: L/`'jGD l-l�.,i�wu /(o`% S�1;ie�la C� CItY� /�i;�.v/���� ZIP:,�_S—y�5' <br /> Email and/or Fax: 7�,� _5�c- ?`i>� <br /> PROJECT INFORMATION: Description of project: L�L�`L '�=- ��.�'�'��� ��� f��'•�'��-- �'r="�-���;� <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewa�e Disposal & <br /> Water Supply <br /> ❑ New Construction �Single Family with $� Accessory Bldg./Garage <br /> �Addition attached garage �Deck �J 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 /> �•rww.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 7��� �'C�'�;� ` <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />