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� �!'fl( OF ORONO RECE!'���, <br /> �E�iL�l�V6� �EF�IVIIT APPLICATION '''�`'�� 1 � Z016 <br /> FOl� �E11� STRUCTURES QR ADDITIOI�NOFORorvo <br /> Mailing Address: ao�� S'� <br /> g. .nTO Permit number: <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: I t ���a��� <br /> ,� �, Street Address:' l eceived by: �u-�d <br /> �'� � 2750 Kelley Parkway `�.b��O �5 lan review fee: <br /> �G Orono, MN 55356 � <br /> l'�'�FSHO� <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 full and all required information must be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: � G/`�" <br /> Job Site Address: Z �'/O � �a5�� � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> If yes, a special 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 sufficienf on-site parking is available. Non permitted events will not be allowed. <br /> CONTRACTOR/APPL ANT IJVFORMATION: /� <br /> Name: y.b�rv� c,� �y <br /> State License# Expiration Date: d / <br /> Phone: cell Z. 'Z U /�� office S`2- y�7 $-S�e <br /> Mailing Address: / Cit : ZIP: ^— <br /> Contact Person: G � Applcant is: C ac / meowner (Circle One) <br /> Email and/or Fax: .e/r c�N rr-,. <br /> n`�� co�. <br /> PROPERTY OWNER INFORM TI N: <br /> Name: <br /> Phone (day): 3 L Z <br /> Address: <br /> Email and/or Fax Cit : ZIP: <br /> �� �1'✓�a% . C A.-- <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: �7��-/� ����. <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage isposal R <br /> ❑ New Construction ❑ Single Family with Accessory Bldg./Garage Water Supply <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 8 permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD ❑ Other:(specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd ^ <br /> Minnetonka,MN 55345 ��.-l�. � <br /> Phone: 952-471-0590 ��� <br /> Fax: 952-471-0682 �1 e�� <br /> www.minnehahacreek.or �v <br /> 1 � <br /> Estimated Construction Valuati�(e I ' g land) $ ��, lJD U <br /> Last Updated: January 2015 <br />