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� City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> MailingAddress: Permit number: �-D���� /f � <br /> � PO Box 66 <br /> � �� Crystal Bay, MN 55323-0066 Date received: q - �5—t � <br /> StreetAddress:' Received b : <br /> �' ,�- 2750 Kelley Parkway � �Z <br /> y�' �` Orono, MN 55356 �� � Plan review fee: <br /> t'�KFSHo�`�" Main: 952-249-4600 Total Fee: �1 <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> 'Ti�is apa�n fc�m must be completed in full and al(required inform��i�t�►c�st be ' _; „ <br /> Mcomplete apptications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �f3��" �o.�.c.���;.� ��r,•�.s..�'�" <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 approval 60 days prior to the event. Shutt/e bus service will be <br /> riequired un/ess app/icant demonstrates su�cient on-site parking is availab/e. Non-permitted events wil/not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: `� <br /> Name: l�c.-t L�.�*�, <br /> State License# � n g Z �SSS Expiration Date: 3 � � Z o r �,. <br /> Phone: (cell) L ��- 70 3 - Z't 53 (office) 4 3'Z.- R�- 9�a-T 9 <br /> Mailing Address: i �'� ��., L�L; !,�c..+ Ci : wc-rt�.,�. ZIP: S'S'.t�S" <br /> Contact Person: ..y Applicant is: ontract / Homeowner <br /> (Circle One) <br /> Email and/or Fax: �-r-Z� ,j ot�,�,.5 •.r� �o l..�c,-t t�.,o�� �„�.,.�, <br /> PROPERTY OWNER INFORMATION: <br /> Name: .J u�..�. �/: v�S <br /> Phone (day): <br /> Address: ZS �w • 1: o.. 'S'f' City: W.-.Y�e— ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFO�MATION: <br /> Name: L� �a.s <br /> Phone (day): �ri'S'2.� 9 ��+ • "�� t'' <br /> Address: /.Sca i L !-��o l�.,_,cy,, "� City: �''�"C+E.� ZIP: SS3 �-� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro�ect: -�-�� . % :� /�� � � �� - �-toCC=� , <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 /> [�PCddition 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) [v]�(�ther: (speCify) ❑Other(SpeCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 r � �� <br /> Phone: 952�71-0590 �'^�� <br /> Fax: 952�71-0682 V,acuc, .a.,"� {� <br /> www.minnehahacreek.or � �` �" ���s0�'°E <br /> Estimated Construction Valuation (excluding land) $ P'�f�.L,pvo <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />