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. City of Orono <br /> " Building Permit Application <br /> for New Structures or Addition �`� 2, 500�. 5p <br /> Mailing Address: Permit number: 2�I 5� i 31�� <br /> �A, PO Box 66 <br /> � `v� Crystal Bay, MN 55323-0066 Date rec8ived: j0��� � S <br /> Street Address:' Received by: _� � <br /> y ,� 2750 Kelley Parkway ZO��j' ���v�� p�an review fee: �� � 1 <br /> �' c,` Orono, MN 55356 __. —--� <br /> ---_ __ <br /> qkEs�o��' Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must b�c�mpleted in full and ail required information must be submitted. <br /> Incomplete applications will be retumed. (Please prinf) <br /> GENERAL INFORMATIO : <br /> Job Site Address: � � ru�r �r � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or oth Display Home? Yes No <br /> !f yes,a specia/event permit is required with Police Deparfinent 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 avaiJable. Non-permitted events will not be allowed. <br /> CONTRACTOR I APPLICANT INFORMATION: <br /> Name: � [C � Co t�S�� <br /> State License# Expiration Date: <br /> Phone: cell - office - <br /> Mailing Address: �J Ci : (D ZIP: S7 <br /> Contact Person: Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: � T����c-�c. �c •�j� <br /> PROPERTY OWNER INFORMATION: ' <br /> Name: <br /> Phone(day): Q S y —�-'1(0-O\3 Z <br /> Address: �74r> �E_G�,Szu�.l. T�tL 'F CitY� D�O�O ZIP� <br /> Email and/or Fax <br /> ARCHITECT 1 ENGINEER INFORMATION: <br /> Name: I-�I�1D'-✓tYl.�- PE51�(�l- �,�C� 'r, 2�N[ `�r -�G 20�gz�Dlfk <br /> Phone(day): �J(�?�, ,��pp <br /> Address: (►Q �-P_AII�A� Si. 1.c). CitY:�� (T(� Z1P� �✓�S� <br /> Email and/or Fax: mi r� ��t� DE- (�•�o� ' <br /> PROJECT INFORMATION: Descri tion of ro�ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water 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 .c. detached garage ❑ Residence <br /> ❑Other: (specify) �� ✓ ❑ Mufti le Famil /Condo ❑ Private Sewer <br /> p y ❑ 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 <br /> ❑ Private Well <br /> Minnehaha Creek Watershed Distrid(MCWD) ❑Othe�: (SpeCify) ❑Othef(SpeCify) <br /> 95320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0882 <br /> www.mi nnehahacreek.or <br /> Estimated Construction Valuation(exGuding land) $ � (/c�(o� <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />