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� <br /> } , � <br /> City of Oronp <br /> � Building Permit Application �-►�'s`��� <br /> �:1�'� <br /> for New Structures or Additions <br /> Mailing Address: <br /> � Q PO Box 66 Permit number: <br /> / � ��, Crystal Bay, MN 55323-0066 Date received: � <br /> I ` ' I Street Address' 'ved b : <br /> '',\„� : 2750 Kelley Parkway �r/L ��� � <br /> '� ,�(� .`; Orono, MN 55356 � 2 pl b"6� Plan review fee:s , <br /> ���r,t{o�� - Main: 952-249-4600 Total Fee: �� �.7!"f • ��� <br /> � `� Fax: 952-249-4616 www.a.orono.mn.us �-��,{'��'ti' ' " �`� ° � ��-- <br /> This application form must be completed in full and all required information must be submitt ' . �y��� ��e1�Gl..,` <br /> Incomplete applications will be returned. (Please print) .� <br /> GENERAL INFORMATION: <br /> Job 5ite Address: I S $Cj ���rd� c,. �t_ Oro�o , m �.1 553g <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes,a specia!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/APPLICANT INFORMATION: <br /> Name: o b�E�'t Gr4� }10 m25 �rL e.. <br /> State License# $c. do y!� Expiration Date: D 31 Zo� <br /> Phone: (cell) (e�2-�4�-tZ2b (office) t��Z- �ldy0 -!2..Z.lo <br /> Mailing Address: �jlr 2"� SF• �uis`-� !�' lOJ Cit : �Xctls rd� ZIP: gS3� I <br /> Contact Person: (Zo b �Ga-eoyGn Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: rJ�e_k��san(p tD a�r+,a..; I , c.onn <br /> PROPERTY OWNER INFORMATION: • , <br /> Name: Cc��o►y„ 2� , Ka,«t.r �x1na,�d j�. K�+-�5e.r' <br /> Phone (day): (o►Z- 1.18- S4oZ <br /> Address: Z$5S P�ov�1a�c.e. �)a�4 City: Z��p�..+�,dre.�,ZIP: 553Sa1 <br /> Email and/or Fax C K q;��r a� �wkG r,�a.�-ian �aQ-d • Go w> <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �jha,r�^a� pr��g►� � Co•�-�pa��.1 <br /> Phone (day): q5 Z- �"'10 - g'T S'p <br /> Address: �},�oH Z^ 5}. Sw� �� ldO City: £�¢1S1or ZIP: r"�1J <br /> Email and/or Fax: ti, q roSS � S►"►a�r a't'1-det��cj►� , Go+�-� <br /> PROJECT INFORMATION: Description of pro'ect: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> � New Construction �J 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) ❑ Multiple Family/Condo ❑ Retaining Wa�l(s) <br /> ❑ Public 4-feet or greater � Public Water <br /> **Any earth movement may require ❑ Commercial ❑Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeClfy) ❑Othe�(SpeClfy) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> Yvww.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ � � ZD� � 0 00 ., d O <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />