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� City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �.(�/ 3 <br /> �Q A>O PO Box 66 <br /> `V Crystal Ba , MN 55323-0066 <br /> Y Date received: S"� � -1 (p <br /> StreetAddress:' Received by: <br /> ' ,� 2750 Kelley Park y����..�i� <br /> y Pian review fee: <br /> F c.� Orono, MN 55356 T <br /> t�KfSHO�� Main: 952-249-4600 Tota . <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in ft.+ll and a11 required information must be submitted. <br /> Incomplete applicationa will be returned. (Please print) <br /> GENERAt INFORMATION: <br /> Job Site Address: � .zeY— ,� ,� '� � '� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> !f yes,a special event permit is required with Po/ice Department and City Counci/approval 60 days prior to the event. Shuttle bus servic ill be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non permitted events will noi be allowed. <br /> CONTRACTOR/APPLICANT tNFORMATION: <br /> Name: i`rt^!F orw�e-S �� <br /> State License# �9 y I �f,� Expiration Date: 3 3 �a r g <br /> Phone: cell Z �-'7 G► A- �-"t�� office f Z �?o – �"� a <br /> Mailing Address: � �-� .��� L Ci :�. �� e� ZIP: ,�"'p �� <br /> Contact Person: Applicant is: ontrac or / Homeowner �ci��e o�� <br /> Email and/or Fax: *� - � � , �w� <br /> PROPERTY OWNER NFORMATION: ,1 n <br /> Name: �-�"t'/� �T1� H�- � ��-N`H.i�► �'tr'N a�c'�' <br /> Phone(day): �,;� – a q�� <br /> Address: �rj 5'� ��t- I�,,.r "'p~n ra-;� �,s�� City: �'�-�.J a ZIP: <br /> Email and/or Fax �-- <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �� �',s�or no i rJC, <br /> Phone (day): .7 b� "'"� (, _ . �(�, �+ <br /> Address: ,L . � Ci : n� � i p'�ZtP: � $��3 � <br /> Email and/or Fax: E-j�� - ��--}-, �— <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 /> 0 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) 6���v1?�1 �6tv ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> �'T"�t ❑ Public 4-feet or greater ❑Pubfic Water <br /> **Any earth movement may require ❑Commercial ❑Storage <br /> MCWD review 8�permits. ❑Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek watershed District(MCW�) ❑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 /> � �;'r� � <br /> Estimated Construction Valuation (excluding land) � - <br /> pri.5e ��h►ov� �?�is� �"`r��si�i �i�o�►�n <br /> Packef Last Updated: August 2015 <br /> Page 21 <br />