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r-�,�-" <br /> � City of Orono <br /> . <br /> • �ui[d�ng Permi� App(ic�tion <br /> far New Structures or A►dditions <br /> Mailing Address: , <br /> g„D�j PO Box 66 Perrnit number: ZD j �p"'OI(��� <br /> Q Crystal Bay, MN 55323-0066 Date received: �' ��.� / <br /> l!i <br /> Street Address:' Received b : <br /> � �C' 2750 Kelley Parkw ''` � � _�� <br /> t,� ��,�� Orono, MN 5535 �� j0 '�� Q`�� Plan reviewfee: / ��� -�z, <br /> kESH� Main: 952-249-4600 � <br /> Fax: 952-249-4616 www.ci.orono.mn.us o a ee: <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: �� S r�F�,N �,�.�� � �r <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes f$� No <br /> If yes,a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shutt/e bus service will be <br /> required un/ess applicant demonstrates sufficient on-site parking is availab/e. Non permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFOR ATI N: <br /> Name: ��-� S ,� <br /> State License# Ex,pJ�r�ation Date: <br /> Phone: cell $'- office ' ,3 y`"/g ' (� <br /> Mailing Address: (o � . . � �P. <br /> Contact Person: !u ;}.{� ' �,, Applicant i • Contra / <br /> Ernail and/or Fax: ne (Circle One) <br /> PROPERTY OWNER WFORMATION: <br /> Name: 1�-'� S �.. t <br /> Phone (day): ► _ b <br /> Address: �G � � . Cit : p N Z�p: <br /> Email and/or Fax �,r � 0 <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Cit : Z�p: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: -f�� ' � �t-`��l 1� ��1 <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> ❑ New Construction ,�Single Family with ❑Accessory Bldg./Garage Water Supply <br /> ,�Addition attached garage ❑ Deck <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial � Public Sewer <br /> ❑ Relocation detached garage esidence <br /> ❑ Other:(specify) � �,Private Sewer <br /> ❑ 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) $ 3��� QQv . g0 <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />