2011-00553 - adv plan review - Laserfiche WebLink

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� �r � � City of Orono Building Permit Application for New Structures or Additions � MailingAddress: Permitnumber: o�� —Db55`� '��,�.� PO Box 66 /0 ,a 0�� Crystal Bay, MN 55323-0066 �Date received: �O`z'�/-/l £X} �SI� Received by: ��a �'�� _ �,�, Street Address:' ��'�, � �x,� �� 2750 Kelley Parkway Plan review fee: ,303• ✓�9 � �6�2 ��t ��,t. t1r �'vG (v�?� J I �'�gE$Hog� Orono, MN 55356 �p/�� p�3 � ``�-_- ' Total Fee: Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us , ��J This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) ��5--,�� GENERAL INFORMATION: Job Site Address: �' � � �,��"� C .�`� �Q,c�G- ��f�� '" Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No 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 required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR/APPL�ANT INFORMATION: Name: �j 6 ir.t �4pri F State License# E.xq+�a�ie+�at�'— Phone: �� t�/�� z�( � (office) �J,S—z �Z� ? �� j� ��z (cell) Mailing Address: � 2 � t=/4-J L � sT Cit :L a u- L�4- r ZIP: s—s—.�s— Contact Person: �_.� f��ty�K F' Applicant is: Contractor / omeowner �c��ie o�e� Email and/or Fax: Z� �,��;�F � T�cT�� S-/-��- c c.� PROPERTY OWNER INFORMATION: Name: ��r, � ,�7 K� /1il z4-� G�4-�'�c=T J'�141�Kr= Phone (day): 61 S'-? 9 z� � � •? � Address: � �-j 2 c� ��s-� J�� T City:L v�>j L�.��LI P:.S—S"�S—�„� Email and/or Fax �'r��y ;�'>�a-��.f��, -�'�-�T-�t��-�S-r4-��1- _ C .� h ARCHITECT/ ENGINEER INFORMATION: Name: ��-/�-fT� d- �f'��c.��l ll�! 7�.�r Phone (day): �� - y7 s —.�--� c � - vJ� Address: y l a N'� �Ty. ,��..t�.�s�Z��v 5-�- City:s`7~��i✓L�y ZIP:��/ �� Email and/or Fax: �..�-2, za 7S- g� S �, � PROJECT INFORMATION: 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& Water Supply ❑ New Construction �Single Family with Residence �Addition attached garage �Garage/Accessory Bldg. [�Public Sewer ❑Accessory Building ❑ Single Family with ❑ Deck ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse ❑ Public ❑ Storage ❑ Public Water ""`Any earth movement may require ❑ Commercial ❑ Other(specify) MCWD review 8�permits. ❑ Industrial [�Private Well Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) 18202 Minnetonka Blvd Deephaven,MN 55391 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or Estimated Construction Valuation (excluding land) $ �c�� c c� .- f,- L