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r , <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Addi�ions <br /> Mailing Address: <br /> Q PO Box 66 Permit number: Z C'�� � ��'�- 7 7 <br /> � �Q Crystal Bay, MN 55323-0066 Date received: � � z� �� <br /> StreetAddress:' __ Received b__y:_____ ���'lC <br /> y� ,� 2750 Kelley Parkw �r�f � Plan review fee: / t� : � <br /> c,` Orono, MN 55356 � � ��6� �� <br /> `�'FESHO�� Main: 952-259-4600 Total Fee: � ��Z, � <br /> Fax: 952-249-4616 w�n�w.c,i.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: ,� , ,, <br /> Job Site Address: ('`(�'•% �>r'c�'��.' ,� ���t�' <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 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 I APPLICANT INFORMATION: <br /> Name: G C��-��t �F��v✓�t' S <br /> State License # �2 l�j�� Expiration Date: <br /> Phone: (cell) �, 1�.-7�(�- ���,�j (office) <br /> Mailing Address: (c+/��-- �-}lSon �1�,.� . Yvy City: �i� �o�n I/' wyZIP: <br /> Contact Person: �f��� � Applicant is: �rrtractor,� Homeowner (CircleOne) <br /> Email and/or Fax: ��t1,�,,,,1�, q�,,,�u,�� {�;,,,,,t�-s : (vvn <br /> PROPERTY OWNER I�FORMATION: <br /> Name: �-'��1y�.c, �-��.M� l <br /> Phone (day): � <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT I ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> -� ter Supply <br /> ew 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 ❑ P � ate 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.minnehahacreek.or <br /> �. 'Z��-- <br /> rstimated Construction Valuation (excluding land) $ ��- �C) G��� � <br /> jcket Last Updated: January 2015 <br /> Page 20 <br />