Laserfiche WebLink
a <br /> , ' . City of Orono j � � � ' <br /> Buildin Permit A lication � �� , <br /> J pp � <br /> for New Structures or Additions � <br /> Mailing Address � �' �� -7� <br /> � � � 1 '-'� �� �� Permit number: C <br /> �QA> POBox66 �;_��• I� � '� / , <br /> `w0 Crystal Bay, MN 55323-0066 Date received: �� Z . <br /> Street Address:' �._..-_- �--- Receive�._by:._._.____._ /��� <br /> � ,� 2750 Kelley Parkway 1 '�: ' <br /> ti � j, - � Plan review fee: - , , 2d <br /> �'t � Orono, MN 55356 � � � ('!� 52 <br /> �xESHO�� Main: 952-249-4600 otal Fee: <br /> Fax: 952-249-4616 w�✓w.ci.orono.mn.us <br /> This application form must be completed in full and all required information must b submitted. r� '� <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ��5 J�r���,►� ��,� /�,, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes f�No <br /> lf 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 /> Nam e: G.'r��t' l�t'�•' �-wv — d'c�J a�/'" <br /> State License# Expiration Date: <br /> Phone: (cell) f�/�_ 35�y- � 9� � (office) <br /> Mailing Address: �„t ' �,o.�( .tl Cit : <br /> Contact Person: Applicant is: Contractor / meowner (Circle One) <br /> Email and/or Fax: ��� ,�~�,��� �,,,,�_ ��„ it?t%CLts��r i�c�-� co�.•+, <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��� � <br /> Phone (day): <br /> Address: c <br /> Email and/or Fax � <br /> ARCHITECT/ENGINEER INFORMATI N: /l ��/' �� ; <br /> Name: /Ylr �`i� .�(,��Cr'So-r�- / (.� <br /> Phone (daY)� �'/�- S1-(v�- /��'Tu�' 9 � � � � <br /> Address � . J� <br /> Email and/or Fax: M /�u„ wr �an �3�a' 6f���" - CO�+� � ',� .� <br /> � <br /> � <br /> ARCHITECT/ ENGI ER INFOR ATION: <br /> Name: � �� ��h p �- ,/� <br /> Phone (day): - _ � f� �1 . <br /> Address: � <br /> Email and/or Fax: 1d ;f /p3�j�ctpl.�a�n <br /> PROJECT INFORMATION: Description of project: r'�,��� �� �r� ,ic..E �i��%( <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> ❑ New 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 ❑ Septic <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) (Compliance certificate <br /> ❑ Public 4-feet or greater may be required) <br /> *"Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review 8�permits. ❑ Industrial ❑Warehouse ❑ Public Water <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other:(speCify) ❑ Other(SpeCify) <br /> 15320 Minnetonka Blvd;Minnetonka,MN 55345 �Private Well <br /> Phone: 952-471-0590 / Fax: 952-471-0682 <br /> www.minnehahacreek.orG <br /> Estimated Construction Valuation (excluding land) $ jsEj �, <br /> Packet Lasf Updated: January 2016 <br /> Page 21 <br />