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i � <br /> �lTY OF C�RONO � O�' � i� <br /> �UIL���G PEl�IV�IT APPLICATION � ��� I <br /> FQl� I`�E�f STRUCTURES QR ���� <br /> ADDITIO�VS <br /> � �j Mailing Address: a���p s�� <br /> ` �'O PO Box 66 Permit number: <br /> Crystal Bay, MN 55323-0066 Date received: � �—�a�� <br /> � � Street Address:' � , eceived by:�� <br /> �n . 2750 Kelley Parkway `Z.b��O �5 lan review fee: <br /> !�'�ESH��� <br /> G Orono, MN 55356 <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 wvrw.ci.orono.mn.us ✓ <br /> This application form must be completed in fuil and aU required information must be submitted. <br /> Incomplete applications will be returned. (P/ease prinf) <br /> GENERAL INFORMATION: /,� � <br /> Jnb Site Address: Z �'/O S �a5�U i�� V`� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> /f yes, a special event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service wil/be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be a//owed. <br /> CONTRACTOR/APPL ANT IJVFORMATION: /� <br /> Name: y�b� c,� �y <br /> State License # Expiration Date: d / <br /> Phone: cell Z 'Z p /[90 office S'2, y7 $��e <br /> Mailing Address: / Cit : ZIP: � <br /> Contact Person: e � Applcant is: C ac / meowner (Circle One) <br /> Email and/or Fax: ,e �N rr-,. �,�< <� <br /> PROPERTY OWNER INFORM Ti N: <br /> Name: <br /> Phone(day): ,�'Z �fZ <br /> Address: <br /> Email and/or Fax Cit : Z�p: <br /> �- "y►�.a: - c °�''-- — Yt 1M 1 Y <br /> ARCHITECT/ ENGINEER INFORMATlON: � +-�`a� � f����l� <br /> Name: <br /> Phone (day): <br /> Address: Cit : Z�p: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: �T��-1�� ���� <br /> 1.Type of Praject 2. Rroposed Use 3. Structure Type 4. Sewage isposal R <br /> ❑ New Construction ❑ Single Family with Accesso Bld /Gara e Water S�apply <br /> rY 9• 9 <br /> ❑Addition attached garage ❑ Deck ❑ Public Sewer <br /> [�ccessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence <br /> ❑ Other:(specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) � Private Sewer <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> '"`Any earth movement may also require ❑ Commercial ❑Storage <br /> MCWD review S 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 /> / � <br /> Estimated Construction Valuation(e I ' g land) � '�Z��, lJD U <br /> Last Updated: January 2015 <br />