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RECEIVED <br /> � - . '��IAN 2 7 2016 <br /> City of Orono � � <br /> � <br /> Building Permit Application C�NOFORON� <br /> for New Structures or Additions <br /> Mailing Address: Permit number: � —(�p <br /> ,/�(�A;�,� PO Box 66 <br /> �v Crystal Bay, MN 55323-0066 /► � Date received: /� 7� � <br /> �� � � Y / <br /> � J StreetAddress:' �� Received by: /�� °J <br /> �y � - 2750 Kelley Parkwa �� Plan review fee: �� i <br /> �� c,��� Orono, MN 55356 �� 4 <br /> �'��rsr+��� Main: 952-249-4600 � Total Feei�,.'_J '���� `� J <br /> —" Fax: 952-249-4616 www.ci.orono.mn.us ptytKA ��,1� r (,�� <br /> This application form must be completed in full and all required information ust be submitted. <br /> Incomplete applications will be returned. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: i L -'�� �.�]L.��c:c�r] _ �; �1 j� <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/APPLI ANT INFORMATION: <br /> Name: �_"T ���j�_,,, j� �� C,c ,1 i E.S <br /> State License# L 1"? " Expiration Date: � 3/ /�r' <br /> Phone: (cell) 1,�17 - �*',re - '7S3 � _ (office) �:j�L= � � �/� <br /> J !�!, <br /> Mailing Address: '=' '�_ �lr��`-I�>>-f1�G�-} �._ i._J� Cit : �.;l�- �Z;'4 ,� ZIP: $=?y/ <br /> Contact Person: �;r.t Applicant is: ,�ontractor' / Homeowner (Circle One) <br /> �._._.� <br /> Email and/or Fax: T e �t 'r �-t ---r > >�S . C'C�M <br /> PROPERTY OWNER INFORnnnrlON: � (� <br /> Name: ���:�A�i'� �'T�'/►�l'€(Z fa t.��� �IL� t'�n 'S���i..%� <br /> Phone (daY)� '7(r 3- `I'>>> - �` `'�(�`i <br /> Address: ��:y� �y�,�,���„� ,��,, ,�' Ciry: �1�1h:,�;�A ZIP: "! ^' <br /> S:� =�a�=- <br /> Email and/or Fax L,11,c. , C-.1t�C i,�� .0 G �l'11�i c.. • r CI rL� <br /> ARCHITECT/ENGINEER INFORMATION: p � <br /> Name: (�r r i;iZ �-�r-� IK�.�.�2 �-i Rc1�l-r€�-t >Qc� �'T�a n�l��-,or�� <br /> Phone (day): Z � �' - �(�j;zc: <br /> Address: Zci lc� '-�,��`; � : -��,-y-�i City:/F1�xr��e � ZIP� r'�'�/"c.� <br /> Email and/or Fax: ��:a«r ���,�a��.z , Cc�fv� ' <br /> PROJECT INFORMATION: Descri tion of roject: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal& <br /> New Construction Water Supply <br /> � ,�'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 B 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&permits. ❑ Industrial ❑Warehouse <br /> '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 <br /> Estimated Construction Valuation (excluding land) $ �, `���%C, ���' <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />