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" ' RECEIVED <br /> � �► � City of Orono <br /> Building Permit Application �«�- � �� �'��� <br /> for New Structures or Additions CITYOFORONO <br /> Mailing Address: <br /> �0� PO Box 66 1,,� Permit number: ���o-�U <br /> � Crystal Bay, MN 55323-0066 ��V� Date received: 7` ��/,6 <br /> Street Address:' � a.,� Received by: <br /> � 2750 Kelle Parkwa - <br /> y�' ��`~ Orono, MN 55356 y � ( P�an review fee: � O�'�f. �.� <br /> j�kESH�� Main: 952-249-4600 � --_ _�ot��e.-----���(� -U(�8'.�� <br /> Fax: 952-249-4616 wwvv.ci.ororio.nin.us <br /> This application form must be completed in full and all required information must be submitted. �� <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � ,,�L�(� ��y`n � -�- ��; � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> 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 <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR!APPLICANT INFORMATION: <br /> Name: '_'j"'"� �1 (>�li� <br /> State License# Expiration Date: <br /> Phone: cell - - C - office ' - �" �'f <br /> Mailing Address: � �[j $�_�r, S-.t- �� City: (���Cj y�,� �� ZI ''�`��' <br /> Contact Person: Applicant is: Contractor / Homeowner �c���ie o�e� <br /> Email and/or Fax: T�Dfl,�1� ,V(11'1t;L C�VY� <br /> PROPERTY OWNER INFORMATION: <br /> Name: '�'� � (��Uk <br /> Phone (day): _ _ ' - W <br /> Address: � � � 1�_5..�- �`C City: �?�j�A,; ZIP: ��'� � � <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type f Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� <br /> Water Supply <br /> ew Construction Single Family with ❑g essory 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) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review 8�permits. ❑ Industrial ❑Warehouse rivate 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 <br /> Estimated Construction Valuation (excluding land) $ ���,�Q� <br /> �� <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />