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� ` . <br /> , . Cit� of Orono • ., <br /> Building Permit App�ication :�..; <br /> for New Structures or Additions <br /> Mailing Address: , ' , � • <br /> �Q� PO Box 66 � Permit number. •-'' u <br /> Q Crystal Bay, MN 55323-0066 Date received: -•� =_�, -� <br /> StreetAddress:' Received by: <br /> y ,� 2750 Kelley Parkway 2p��c' W�G <br /> �, (�b'3 lan revie fe . . <br /> �� Orono, MN 55356 ;.- . <br /> t9KESH0��' Main: 952-249-4600 Total Fee: ` � <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be comp►eted in#ull and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL IN�ORMATION: <br /> Job Site Address: z�( g� C,c��Gp �0?l1� Qc� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �f No <br /> !f yes, a special event permit is required with Police Department and City Council approva/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: _ASPEN �UILDFRS �' R�'/ND FLErQS ING• <br /> State License# ���,t`8!6 Expiration Date: 3-��-ZDt�. <br /> Phone: cell - - office 2. $dp <br /> Mailing Address: 54/ WgSH11�l6' ON O Cit : ' ZIP: 5 <br /> Contact Person: �Or L�`I Z. Applicant is: Contractor / �Homeowner (CircleOne) <br /> Email and/or Fax: Jor� QS Per�s L+�wr'oa�u• t�owl <br /> PROPERTY OWNER WFORMATION: <br /> Name: � e he.� 1R � <br /> Phone (day): � _ <br /> Address: 2 Cit : ZIP: <br /> Email and/or Fax S GY2. tU dol ek C�o uct Ineo. t�0►'►+� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: �� � ���b � �� ��" <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 <br /> �Accessory Building ❑ Sin le Famil with ❑ Public Sewer <br /> g y ❑ Office/Commercial <br /> Relocation l detached garage ❑ Residence ❑ Private Sewer <br /> Other:(specify) �OWf �/►�(��. ❑ 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 <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: s eci ❑ Private Well <br /> 15320 Minnetonka Blvd' � p �� ❑ Othef(speCify) <br /> Minnetonka,MN 85345 . � - ,� , <br /> Phone: 952-471-0590 ' � <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> �n� � <br /> Estimated Construction Valuation (excluding land) $ �5•c.Vl�,_ <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />