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_ . � �r . . �°��ko e,'� City of Orono � ��- Building Permit Application -�° for New Structures or Additions Mailing Address: Permit number: ��5- O PO Box 66 �� �" �Q Crystal Bay, MN 55323-0066 � Date receive��"�' �-/�-� StreetAddress:' � � y ,� 2750 Kelley Parkway � 3�� _P n review f e: � �' c,` Orono, MN 55356 ��kESH�� Main: 952-249-4600 Total Fee: Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required information rnust be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job SiteAddress: 33�9 ��S-�a� �ccY ��, �.layza�"a�, rnlU SS3�' � Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will nof be allowed. CONTRACTOR/APPLtCANT INFORMATION: - Name: S� �i u c�i G . State License# "g L(� Z( 5 I S Expiration Date: 3 3� Phone: (cell) f�Z-- 1 Z/_ S�n � (office) �s a- '�17�1—� `�76 Mailing Address: �p � v Cit : � Il3a ZIP: � Contact Perso 5-��c.-V e �i s h�e,� Applicant is: ontractor / omeowner (Circle One) Email and/o Fax: 95a,� �l7 N - 'L 1 0 � PROPERTY OWNER INFORMATION: Name: U �� .f.h S I n Phone (day): -S -Zg 4 Ad s: '��y� G1ryc��.( �cc�, (Zowd City: (i,�a�za,-�Q ZIP: $�S3`1/ Email nd/or Fax ��hStv►w �vi,�, e� 4 mc�.i 1� c,rm• ARCHITECT/ENGINEER INFORMATION: Name: (�i c.h a,re�. C rQ h Phone (day): C,l 6 t 2-SS y - �j 7 7 o��t�� 6�z - �a.�- s�o� Address: y 3�S �'as�t Sa+n S'1' City: /��p,Q,�af�S ZIP: �S�/ � Emai and/or Fax: (� Z a a � PROJECT INFORMATION: Description of project: �� •�� 1.Type of Project 2. Proposed Use 3. Structure T pe 4. Sewage Disposal 8� �o Water Supply �New Construction �ingle 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.minnehahacreek.or Estimated Construction Valuation (excluding land) $ qQ, �O Q Packet Last Updated: August 2015 Page 21