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� �, <br /> ; <br /> CI�'Y OF �RONO � �' <br /> �� 1 � . <br /> BUILDING PERMtT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �.�'��� Mailing Address: Permit number: a�10—� ,5 <br /> � PO Box 66 �_ ^_/ <br /> � Crystal Bay, MN 55323-0066 Date received: �`� � <br /> 4J � <br /> `� ,,� Sfreet Address:' I� Received by: <br /> "`yF G� 2750 Kelley Parkway �' Plan review fee: ��CO��D� <br /> �.q��s�o��. Orono, MN 55356 ' �/� <br /> Main: 952-249-4600 � Total ee: ��� �T" <br /> ' Fax: 952-249-4616 wwv�.ci.orono.mn.us ' �� f- �Id, <br /> This application form must be completed in fuil and all required in#armat on must be submitted. <br /> Incomplete applications will be returne�i. (Please print) <br /> �ENERAL INFORMATION: <br /> Job Site Address: �i� (�� d��s-�- �0.KC S+ , �I"C?��C� � �'�f�.� _`� S�SC� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes QQ No <br /> If yes, a specia/event permit is required with Police Department and City Councii approval 60 days prior to the event. Shuttle bus service wil!be <br /> required unless applicant demonstrates sufficieni on-site parking is availab/e. Non-permitted events wiil not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �ji.�fSS�� �j�xi (del'S <br /> State LicLnse# (3� C�C� I � 3�► Expiration Date: � 3� ��i <br /> Phone: cell) office 5 I -(o�5 � C-;j 3 I <br /> Mailing ^_.�,��ress 5�-I �T���nS �r�' c� . S-I� 1(�13 Cit : . } _ ���I ZIP: js� I��f <br /> Cantacr �arson: �,�,�, �,,,�h -„ Applicant is: ontractor � / Homeowner (CircleOne) <br /> Email and/or =2X: /�,»r'ua..ho ra ��-� <co ( h t� �c� r s_ Cam,� <br /> Pl20PER1"Y OWNER INFORMATION: <br /> � Pvame: C���-i5`�Lp�1t=r' LCLp(��'1 <br /> Phone (day}: 95�-�I� �-1 - (�l�� � — <br /> C'c�J l� <br /> Audress: 3�U� �-CkS� L l�K E S Citv� �(D��C� ZIP: J.� .�.� � <br /> Emailand/orFax �! l��_pp��� :�(tr � �1M�� • C��'''� <br /> �RCHITEC;?�;ENGINEER INFORMATION: <br /> �ama: —�'4 -- <br /> Phor�e (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PF20JECT INFORr►/IATION: Description af p�oject: <br /> T'I ype Qf Project 2. Proposed Use 3.Structure Type 4. Sawage Disposal & <br /> 1iVater Supply <br /> �,�t�le��v Construction II ❑ Single Family with �Accessory Bldg. /Garage � <br /> � Ar'dition � attached garage ❑ Deck <br /> � ccesso Buildin �Public Sewer <br /> i� ry g � ❑ Single Family with ❑ Oifice/Commercial <br /> ❑ Reloca?ion detached garage ❑ Residence <br /> ❑ Private Sewer <br /> �I ❑ Other: (specify) ❑ Multiple ramily/Condo ❑ Retaining Wall(s) <br /> � � ❑ Public 4-feet er greater �?(Public Water <br /> '*Any earth movement may also require � ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrizi ❑Warehou�e ❑ Private Well <br /> �I Minnehaha Creek 1,Naiershed District(MCWD) � ❑ Other. (speCify; i ❑ Other(speCif�� ' <br /> 15320 Minnet�nka Blvd � j <br /> I �vtinnetor,Ka, MN 55345 -- <br /> ! �hone: 952-4?1-0590 �i I <br /> � �ax: 952-=+71-0682 I � <br /> � � <br /> I W��,vw.minr;;l�ahacreek.orq � <br /> $ `�' �r� <br /> Estimated Construction Valuation (excluding land) /�, � ,3 <br /> --— ---�-�-- <br /> �ast Jpdated: January 2016 <br />