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O�t, 6, 2015 2; 14PM Sala Commer: lal N��. ??E� P. 2 <br /> � --' CITY OF �I�ONO <br /> � BUI�.D�NG �'�RMIT APPL(cAT14N <br /> FOR NEW $TRUCTURES OR ADbITIQNS <br /> �r Mailing Address: t-. �� <br /> PO Box 6B Permft number; � � _-� �1 �. � -� <br /> ��V� Crystal�ay,MN 55323-UU66 Qate recelved: L � �r � I C <br /> .� <br /> Str�et Address:� Received by, �ri--� <br /> �y� � , 2750 Kelley parkway Plan review fee: �' �' � <br /> �,G Orono,MN 55356 y <br /> ��k�SHot� <br /> Total Fee: �l1� ��? <br /> Maln� 952-249-460D Fax: 952-249-4616 �.cl.orono.mn.us <br /> This application form must be completed in full and all required information must be subrnitted. <br /> Incomplete appllcatlons wlll be returned. (Please print) <br /> GENERAL 1NFORMATION: U t�/-t'� V 1� � <br /> Job Site Address: <br /> Will this be a parade of Homes, Remodelers Showcase Home or other bisplay Home? Yes No <br /> If yes, a special event permit is required with Police Department a�1d Cl7y Counell app+'Oval 60 day3 p�lor to the event- Shuttle bUs servlce w1/1 be <br /> requiYed unless applicanf demonstretes suflicient on-sile parking is available. Non-permllted ev�nfS wl!!not be allowed. <br /> GONTRACTOR/APP I�NT INF MATIOIV• n !�r f <br /> N 2 rT�e: ff <br /> State License# Expiration Date: � <br /> phone; cell offce J <br /> Mailing Address: , Cit : <br /> Cont2ct PerSorr. �/I Applicant is: ontractor / Homeowner �cir�ie o�e� <br /> Email and/or Fax: i,�•f�31� �.1_ <br /> PROPERTY OWNER IN ORMA ION: <br /> Narne: <br /> Phone(tlay)� r ��...�uw.�,..�_ <br /> Address: ,� � l - Cit : Z1P: <br /> Email and/or Fax <br /> ARCHI7ECT 1 ENGINEER I �ORMATION: <br /> N ame: ���}- <br /> Phone(day); r� <br /> Addr�ss: �J City: ZIP: <br /> Email and/or Fax: ����J <br /> PR4JECT INFORMATION: Descri tion of ro'ect; Q-� �-- <br /> 1.Type of ProJect 2.Proposed Use 3. ucture Typ �.Sewac�e Dlsposai& <br /> Water Supply <br /> �] New Construction ingle Family with �Residence <br /> �]Addltlon attaehod gafage ❑Garage/Accessory Sldg. ❑Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> �Oelocation detaehmd garage ❑qfficelCommercial ❑ Pri�ate Sewer <br /> ther. (speclfy) ❑Multiple Family/Condo ❑Warehouse <br /> ���t r�/�(� '��—' ❑Public ❑Storege ❑ Public Water <br /> `*Any eartli movement may also equlre ❑Commerclal ❑Other(specify) <br /> pqCWp ravlaw&perrnit;s. ❑ Industrial [] Private Well <br /> M�nnehaha Creek Walershed Qlstrlcl(MCVW) ❑ Other. (speclfy) <br /> i92Q2 Minnetonka Blvd �, <br /> Deephaven,MN 55391 � <br /> Phone: 9521171-0590 i � <br /> �ax: 952-474-U&62 � <br /> v�nvw.minnehahacreek.or � <br /> �stimated Construction Valuation (exclucling land} � � . ��, � <br />