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. <br /> City of Orono <br /> Building Permit Application <br /> `` for New Structures or Additions <br /> Mailing Address: Permit number. ?� I � -��j <br /> � �(� PO Box 66 <br /> Q Crystal Bay, MN 55323-0066 Date received: - - <br /> StreetAddress:' Received • <br /> y ,� 2750 Kelley Park P al n review fee: - �70 <br /> �'� L� Orono, MN 55356 ��+�(�,- � <br /> �XESH04� Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.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: /��3 J` 3��?� � �v�'lf ��` ' <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ❑ No <br /> /f yes,a specia/event permit is required with Po/ice Department and City Counci/approva/60 days prior to the event. Shuttle us service wi//be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. n ST D S•(.�pw-����� <br /> r� ,�- <br /> CONTRACTOR/APP ICANT INFORMATION: <br /> Name: c�r1 ���C'� Ct�G� .S�„`S <br /> State License# LGC� YE� Expiration Date: �! 7 <br /> Phone: cell ��- lU � 7 office s'a- �13�- i„a <br /> MailingAddress: L{ � ;.��d[� ,. Cit : di� �, ZIP: � <br /> ContactPerson: �� hn KT�Q,-.er Applicantis: Contractor / Homeowner (CircleOne) <br /> Email and/or Fax: �c �-.����'�.��v r�Svn.S'. CC� <br /> PROPERTY OWNER INFO MATION: <br /> Name: �c��/�/�'lcas�2 ���L't�G(� 'Ti��-.s� <br /> Phone (day): � - ' (�, <br /> Address: ol^ teo� �cw SU'� Cit : ���-�°�fc" ZIP: G � <br /> Email andbr Fax v � �'�"��t:l , ��i`"► <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �'f-f�lZ e �4TT ��S���V <br /> Phone (day): - 7� - ' ,�^ <br /> Address: % a� �,' Cit : �y� �e l�r'r� ZIP: �J �� � <br /> Email and/or Fax: ' c,� ,�, • o <br /> PROJECT INFORMATION: Descri tion of ro�ect: ��w S'� f� Y�' �` �"`''{ o� V�ev►��-- �a-�- <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ew Construction �.Single Family with ❑Accessory Bldg./Garage <br /> Addition attached garage ❑ Deck �Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ O�ce/Commercial <br /> ❑ Relocation detached garage �esidence <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 �[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) $ ` / �O f!U� G U Q <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />