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�-----a <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: r <br /> �,�T PO Box 66 Permit number: '�b�5-��) <br /> � �vQ Crystal Bay, MN 55323-0066 Date received: j"Z� �� <br /> . <br /> St�etAddress:' _-_-- __---__ eG�ived�:�� _��_. <br /> y ,� 2750 Kelley Par y, � � �. � � � 5.-� ,4� _ Z <br /> �'t �� Orono, MN 55356 �'�5 _�'�'� Plan review fee: i � <br /> qk�sxo��' Main: 952-259-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci. ron .mn. <br /> This application form must be completed in fu�l and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> G�ENERAL INFORMATION: <br /> Job Site Address: � �r�-� <br /> �Will this be a Parade of Homes, Remodel Showcase Home or other Display Home? Yes No <br /> If yes,a special event permit is required with Police�epartment and City Council approval 60 days prior to the event Shuttle bus service will be <br /> required unless applicant demonstrates s�cient on-site parking is available. Non-permitted events will not be al/owed. <br /> CONTRACTOR/APPLICANT INFO T N: <br /> Name: `� <br /> State License# Expiration Date: <br /> Phone: cell fp 2>3 -'73� office <br /> Mailing Address: ((pr03 � Cit : ZIP: � <br /> Contact Person: Applicant is: Contract r / Homeowner Circle One) <br /> Email and/or Fax: .� <br /> PROPERTY OWNE INF RMATION• . <br /> Name: � '►�, ���p�- <br /> Phone (day): �3 �,- 2 <br /> Address: 0 tr Cit : ZIP:� 1 <br /> Email and/or Fax ,�p <br /> ARCHITECT/ENGI I.��R� INF RM�4?ON• <br /> Name: ��j� YC-t1 . � <br /> Phone (day): - <br /> Address: `"� I Cit : ZIP: � <br /> Email and/or Fax: r <br /> PROJECT INFORMATION: Descri tion of pro�ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure T <br /> ype 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 8�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.minn h h k. r <br /> Estimated Construction Valuation (excluding land) $ ��'�, � <br /> . <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />