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, . <br /> City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: <br /> PO Box 66 Permit number: � ' <br /> ���(� Crystal Bay, MN 55323-0066 Date received: � I"���O <br /> , <br /> Street Address:' __---.-�---._, ceived by: � <br /> _ -------___.__---�___ ._.._� <br /> �y ,� 2750 Kelley Parkway '�G!1�`��q 1 Plan review fee: � '7 <br /> F�� 4��` Orono,MN 55356 � -�-I l.� (��Q� __----------- --�.—_- -- <br /> kE5N0 Main: 952-249-4600 � Total Fee: <br /> Fax: 952-249-4616 www.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. (Please print) <br /> GENERAL INFORMATION: � <br /> Job Site Address: R - ^ �,� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> H 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 sufficient on-site parking is available. Non permitted events wil/not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: l,�'�v'� �r�`�Q }1��n-i�C C��L(�` <br /> State License# �C („3��g 3l� Expiration Date: <br /> Phone: cell t 2�- -t"1�o-- ofFce <br /> Mailing Address: � � -�-" � Ci : "' "n1 ;t ZIP: �('1 <br /> Contact Person: � � Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: L , � ra►o,:,l �c�,-,� <br /> T� �l SZ.-(�l�Z'�"1._? <br /> PROPERTY OWNER INFORMATION: <br /> Name: �Z►�7� I���Z-(� <br /> Phone (day): "7�o��- 5 S�'1�- �3i-I�� <br /> Address: yZc� a2���. Ci : �t�. ZIP: ��� <br /> Email and/or Fax ,�, v�n�, � �c2 ,� <br /> ARCHITECT 1 ENGINEER INFORMATION: <br /> Name: ��� ���,�'.�r�6 �- 0�-s�N <br /> Phone(day): �to'3-- '► �cd �o��..� s <br /> Address �o� -Y- � T ' � c Ci : `�U�"�� ZIP: c./ <br /> Email and/or Fax: ��Q ��,�,�tJ c o,,v� ���--1�;�:. -�',.�,� <br /> PROJECT INFORMATION: Descri tion of ro'ect: ���� <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> �IVew Construction �Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ❑Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage �-Residence �-Private Sewer <br /> ❑Other: (specify) ❑ Muftiple Family/Condo ❑Retaining Wall(s) <br /> ❑ Public 4feet or greater ❑Public Water <br /> ""`Any earth movement may requlre ❑Commercial ❑Storage <br /> MCWD review 8 permits. ❑ Industrial ❑Warehouse �$,Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑Othe�(specity) � <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ J�`� i�o� <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />