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� ' <br /> .. � � � <br /> City of Orono <br /> Building Permit Application �____�_ <br /> for New Structures or Addition �S�� 2; 5co `c�. �o�� <br /> Mailing Address: <br /> , � QA�. PO Box 66 Permit number. 2�t 5- �' I 3(�� <br /> / � `�0� Crystal Bay, MN 55323-0066 Date received: �b��l I � S <br /> 1 <br /> � �, '/I Street Address:' -; --- Received by: � y�y� � <br /> ��i\ � 2750 Kelley Parkway "���j� 0�3�P� �� � <br /> Plan review fee: �_� � <br /> � ' � � Orono, MN 55356 ___.__ <br /> �"��r��`` Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 .ti,nr,v�.' orono.mn.us <br /> This application form must be completed in full and ail required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL tNFORMATIO�V: , <br /> JobSiteAddress: - � �-�(� ` - ��,I " ��y_ L �,� �'� ���' <br /> Will this be a Parade of Homes, Remodelers Showcase Home or oth Display Home? Yes No <br /> If yes,a specia/event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service wil/be <br /> required un/ess applicant demonstrates su�cient on-site parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �. C�(t t� � C`p I�S'�, <br /> State License# Q Expiration Date: <br /> Phone: cell - - office <br /> Mailing Address: LkJ Ci : r� ZIP: S 7 <br /> Contact Person: Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: hl�l I D�TT(���C-�h.L .�oM <br /> PROPERTY OWNER INFORMATION: <br /> Name: �P.�CIr �- kUr{,i'2 �.�,Yl� <br /> Phone (daY)� �iSZ -�'1�v-�t'3`L- <br /> Address: 274C� �7EF�- Kut.l TP-A(L 'F- . City: �tip�p ZIP� 55�(� <br /> Email and/or Fax <br /> ARCHITECT!ENGINEER INFORMATION: � �� I <br /> Name: LAf�(�t-Yl��. i�S�lati1- � C°ot�ST�, yp �M �-���p.i-�G20�F�aD?1-�' <br /> Phone(day): �l/„�,-�'La-�Z,pO <br /> Address: �_(Q_�,l�q� ��. �,J� City:(�o�(Tv ZIP: ��5� <br /> Email and/or Fax: _ �m�n�d,�t t�_� fGr-(•�o� <br /> PROJECT INFORMATION: Descri tion of ro�ect: l�-�� ' ���' <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <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 detached garage ❑ Residence <br /> ❑Other: (specify) �� S ❑Multiple Family/Condo ❑Retaining Wall(s) <br /> ❑ Public 4-feet or greater j�Public Water <br /> "'Any earth movement may require ❑ Commercial ❑Storage <br /> MCWD review 8�permits. ❑ Industrial ❑Warehouse , <br /> Minnehaha Creek Watershed District(MCWD) ❑Othef: (SpeCify) ❑Othef(SpeCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0882 <br /> wv,�v.minnehahacreek or <br /> Estimated Construction Valuation (excluding land) $ � �,v(�� <br /> Packet Last Updated.� August 2015 <br /> Page 21 <br />