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Cit of Orono � a � <br /> y � � � � <br /> Building Permit Application °�� <br /> for New Structures or Additions <br /> Mailing Address: <br /> A,. PO Box 66 Permit number: /,�j���� b' <br /> �O`VQ Crystal Bay, MN 55323-0066 � Date receiv�d: 7'i��—/� <br /> �, ;.� <br /> StreetAddress:' � ��Y� <br /> 2750 Kelley Parkway <br /> 5��, � Plan review fee: � � , • <br /> c? Orono, MN 55356 <br /> lqKf5H0�� Main: 952-249-4600 Tota ee: �� �' <br /> Fax: 952-249-4616 www.ci.orono.mn.us o�0/� <br /> This application form must be completed in full and all required information must be submitted. 0/97 <br /> Incomplete applications will be returned. (Please print)'',,,,p" <br /> GENERAL INFORMATION: w�� �� 0��(�,�9,n�—�p�c,�C� <br /> Job Site Address: ��� �� ��t �����`��,fi ���'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 approva160 days prior to the event. Shuttle bus servic w 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: )t,V 'a �1�� ���:��lu ('�1� 11�}(�cC-i�C`.r-'—:� L��ZC� <br /> State License# ��C. ���,'�l�c� Expiration Date: <br /> Phone: (cell) �t�� J�J�� �����7Za (office) �C�� ���-1 �� 3 C� <br /> Mailing Address: ? �,.� ct0 Cit : �� ��= �� ZIP: �j���_�-: <br /> Contact Person: 1�1'1��R j Applicant is: ntractor / Homeowner (Circle One) <br /> Email and/or Fax: ;i'�(`1-, T Z�f�i( ��(1M�ruU�( ' •C �`Y� <br /> PROPERTY OWNER IN�ORMATION: <br /> Name: F�� l ; ;�, �_�'11(l1�CQ- �i`Cl�(.'Y� <br /> Phone (day): -�� '� • �`��'4 <br /> Address: ,�1� \ �C��'�nS Lrl �v Cit : ( �rYl�i:;�.�-C`�4� ZIP: 4`'j��L� � <br /> Email and/or Fax ' ' P 6�1 r rv �-, <br /> `� � <br /> ARCHITECT/ENGINEER INFORMATION: � O C �La'I�O <br /> Name: <br /> Phone (day): <br /> Address: City: ZI P: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> �-�Vew 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 �esidence ❑ 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 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) $ �,�� ���� v� <br /> Packet Last Updated: January 2015 <br /> Paae 20 <br />