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: , � � . �� <br /> ��� <br /> City of Orono �� � � <br /> Building Permit Application � <br /> for New Structures or Additions <br /> ,,---_\ Mailing Address: Permit number: �� � <br /> � QA, PO Box 66 <br /> � `VQ� Crystal Bay, MN 55323-0066I /� � Date received: �� �.S�S <br /> �" � <br /> � � � Street Address:' (j �� �, Received by: /�� <br /> �� � � 2750 Kelley Parkway � �I�� Plan review fee: / S�c7• 1j 7 <br /> �` c,� Orono, MN 55356 <br /> \!�ESH�Q'� Main: 952-249-4600 Total Fee: `-''�'�f�^���3 <br /> Fax: 952-249-4616 www.ci orono.mn.us � �. ���p�✓ <br /> This application form must be completed in full and all required information must be s mitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: ,� <br /> Job Site Address: �; �� '_� r ► , ���. �� 1�c�.;,�1 ��;' e�� ' �r C-�r,c� `1�1 ti <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Disp ay Home? Yes � No <br /> lf yes, a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus servrce will be <br /> required un/ess applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT I FORMATIQ.�: ^ <br /> Name: � ,, �� }��'�.r �.��� �: •�Y a ,-vs��i-�� <br /> State License# -:�'; ;�j�1�" Expiration Date: (�3 3� 2U1 <br /> Phone: (cell) � �2 =- 31��i- �-1 . (office) � S Z - � � .- � . �' � x • 3 1 <br /> Mailing Address: ��� '� a• „ r�Z '', ,° City: �; % � cy��•� ZIP: �`� �`t 1 <br /> Contact Person: (-:l_���.�; ,�.- ,,�„�;_ �. M-� Applicant is: ontracto �/ Homeowner (Cirde One) <br /> Email and/or Fax: �_ljE��,�� 4-�a+--�.Y.c��„� ��:� I�uIP_ ���_.,-�- l�C.tr- r�,-� . c r �,;� <br /> J <br /> PROPERTY OWNER INFORMATION: <br /> Name: �•��-.� � .► l�ct�'�� n �J i. �G�n <br /> Phone (day): �t-} '-i �.- '1 C. -- (U�.-1�'1 ..;-�-) z-`7 y f-�1 2�{ f' K-i.) ' �z-�Z-'a - � l-1 �t <br /> Address: � � — r�-. _.. Ci : r '? ;� ZIP: ;�� 3�;i I <br /> Email and/or Fax � t� ,� .'� ` ;` ` j lft,' c�,� . • �' ; • L�,�,-� <br /> ARCHITECT/ENGINEER INFO ATION: <br /> Name: �jh � � C�4. <br /> Phone (day): � �-• c� <br /> Address: Ci : cY ZIP: J�3� <br /> Email and/or Fax: � � <br /> PROJECT INFORMATION: Descri tion of ro�ect: <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 ❑ 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) $ 3'�t�,� <br /> Packet Last Updated. August 2015 <br /> Page 21 <br />