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, i <br /> City of Orono ` `� , �� <br /> . ��I ,/g`3 5 <br /> Buildin Permit A lication `� <br /> J pp / <br /> for New Structures or Additions <br /> Mailing Address: � <br /> A, PO Box 66 Permit number. ';C ' t�` <br /> ��`v� Crystal Bay, MN 55323-0066 Date received: ' � I")�C' <br /> I Street Address:' Beceived by: �{) <br /> � R �� Orono, MN 55356 , ,_ C�� ���� Plan review fee: , ,� ' `� � <br /> � 2750 Kelley Parkway ; <br /> � ; <br /> ',`�s Ho�� Fax: 952-249-4616 www.c���C-�_�_Q� _ _ <br /> Main: 952-249-4600 Total Fee: <br /> orono.mn.us {/ <br /> This application form must be completed in fult and all required information must be sub itted. <br /> Incomplete applications will be returned. (Please print) �� ��-�- � <br /> GENERAL INFORMATION: �V �,��� � -� �O <br /> Job Site Address: ' � �,3 '�' . � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> K 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 will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: l.�J'�tv'� �r�`Q '�.�v�,� G�2P� <br /> State License# �j C_ (�� �q 3�. Expiration Date: <br /> Phone: cell ,�- —1'1 a-- o�ce <br /> Mailing Address: Z,�" ''� Ci : � �,' ,� ZIP: �-1� <br /> Contact Person: � � e • Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: � , , � 1 rv�„1 ,c�,:-�n <br /> � �iSZ-(�l- Z'3'�-1 <br /> PROPERTY OWNER INFORMATION: <br /> Name: Z��� N�'�-(� <br /> Phone (day): Y7��- 5 Sq- o�y��3 <br /> Address �yZ� ���-��, Ci : „rw..&t�. ZIP: ��t' <br /> Email and/or Fax ,�� � v�n, �� ,c�r <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �f� ���1►�'.1Jv 6 � ��-S�l� <br /> Phone(day): •'1�3-- '� �c%-- ��;G� � <br /> Address: e� • z--� -r �� c Ci : �t,��1�'u�� ZIP: �{ <br /> Email and/orFax: D�p ��t,�-.,t�J' c;;�c,,�t, ���;-��� —;�; <br /> - <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 �esidence �-Private Sewer <br /> ❑Other: (specify) ❑Muftiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4feet or greater ❑ Public Water <br /> **Any earth movement may 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 <br /> Phone: 952-471-0590 � �� � � �"� <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or � 2 � � , 5 � <br /> J <br /> Estimated Construction Valuation (excluding land) $ �J (� ��a� � <br /> ��j � � - � <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />