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<br /> City of Orono � � �L;�S.
<br /> Building Permit Application �
<br /> for New Structures or Additions
<br /> _�� Mailing Address: -, ��-�
<br /> PO Box 66 �C��-�' �
<br /> ��0��, Permit number. - /1 � 1 �
<br /> �� � Crystal Bay, MN 55323-0066 Date received: �� - �5--(
<br /> %
<br /> � � 1'� � , � StreetAddress:' _ ._ _ Received b : � �
<br /> �, � ,�t� 2750 Kelle Parkwa
<br /> ��y,� �' y y (r ` �� r - Plan review fee: �. � �
<br /> ��`�kE,`s H�`�/ MainO 952 24�600 6 �� � > _-�-�-�-�--------_ __ __ _ ___—.._ 1�'1�
<br /> i Total Fee:
<br /> Fax: 952-249-4616 www.ci.orono.mn.us
<br /> This application form must be completed in full and all required information must e submitted.
<br /> Incomplete applications will be returned. (P/ease print)
<br /> GENERAL INFORMATION:
<br /> Job Site Address: � �.::� , '. ;:�✓: :. ,��,, .:�. �,.�... �..�..�.�;.�.,,�'�.
<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 approva/60 days prior to the event. Shuttle bus service will be
<br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed.
<br /> CONTRACTOR/APPLICANT INFORMATION:
<br /> Name: �< <;,,. -$ �.,,•w.� ,
<br /> State License# 2, c, 'S t r?s� Expiration Date: ? � �a � 2�+ C.
<br /> Phone: (cell) L ��-- 70 3 - �2 5 3 (o�ce) 9 5 2� '?�F� - �4 pj��
<br /> Mailing Address: i s'� i 7` t..L: t.� c... Cit : w��� ZIP: r'�'� � �
<br /> Contact Person: �-���....t Applicant is: ontracto / Homeowner �c�.��o�e�
<br /> Email and/or Fax: �`... �-� .� �t,..H..�. ...� .� � �. �-.. .�,..-P-�6�� .;�.«.�.�.
<br /> PROPERTY OWNER INFORMATION:
<br /> Name: ...�v�v� V..f - �� c,
<br /> Phone (day): ��v JJr��s.
<br /> Address: ' Z� -��+ - �'• �-- �"�" HOMES & REMODELING
<br /> Email and/or Fax
<br /> Paul Weld
<br /> - ARCHITECT/ENGINEER INFO�MATION: Cett:6�z.3oo.�2,0
<br /> � Name: L �.c u , .�.w pauhueld@(ecyGros.com �
<br /> - Phone (day): r S x.. M ��? �-. ,.� �, ,� ,,� .,e
<br /> • Address: ���, � u` �} � �5�1z Hiyhivay 7 �Minnetonka,MN g5345
<br /> 4 � `''�'f 95r•944•9499 � lecybros.com
<br /> Email and/or Fax:
<br /> �,i«mse urtc,•i2,ssss
<br /> PROJECT INFORMATION: Descri tion of ro�ect: .-1 j� ��� ', /'� . , � t—� / �", l 1<�"l./
<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 /> [�ddition 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 8 permits. ❑ Industrial ❑Warehouse ❑ Private Well
<br /> Minnehaha Creek Watershed District(MCWD) ��ther: (speCify) ❑Other(speCify)
<br /> 15320 Minnetonka Blvd
<br /> Minnetonka,MN 55345 r
<br /> Phone: 952�71-0590 't`'°~� .�-���'�
<br /> Fax: 952�71-0682 \y o,��,w, .�,,,,,.�.�,� " ;
<br /> � /.a o�f .
<br /> www.minnehahacreek.or � '' �` �,�
<br /> Estimated Construction Valuation (excluding land) $ t `f.L, u��
<br /> Packet Last Updated: August 2015
<br /> Page 21
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