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� r � City of Orono ,9� <br /> � ' ' �g�� <br /> �ild�ng� Permit Appl�cation � <br /> for New Structures or AQI'ditions <br /> Mailing Address: , ,� <br /> Q PO Box 66 Permit number: �.(-�I IC�'-C-�/l-�'�-�r' <br /> � �Q Crystal Bay, MN 55323-0066 Date received: � �Z- �� (p <br /> Street Address:' � Received by: L�`� � $ ��� <br /> � ,� 2750 Kelley Parkw � --- �� <br /> y . � (� .(J I a�� Plan review fee: ) � '7� � <br /> '� � Orono, MN 5535 �D <br /> , ; <br /> 9xESH04� Main: 952-249-4600 K' -------___- --___ _._ _.._ <br /> o a ee: <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: �� � r�F�1 [��Q..L�� � � <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes � No <br /> lf yes,a special event permit is required with Police Department and City Council approva/60 days prior to the event. Shutt/e 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 INFORf)AATI N: <br /> Name: 5 Ef� S � `"�� <br /> State License# � �� ExpJ'r�ation Date: <br /> Phone: cell �� office ' °.3 `�'/9 �r <br /> Mailing Address: G� ' /9-r j t, - IP: <br /> Contact Person: lu� ,�-r2. � ' . �, Applicant i � Contra / ne (Circle One) <br /> Email and/or Fax: (� S ���� . � <br /> PROPERTY OWNER WFORMATION: <br /> Name: 1�-� S �.� t <br /> Phone (day): � _ � <br /> Address: �G � � • Cit : D IV ZIP: <br /> Email and/or Fax � � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Cit � ZIP• <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: r' i� ��}1r+ ( `� �I�� t�� ��� <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal& <br /> ❑ New Construction Sin le Famil with �Nater Supply <br /> � 9 y ❑Accessory Bldg./Garage <br /> ,�Addition attached garage ❑ Deck <br /> ❑ 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. ❑ Industria� ❑Warehouse �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (SpeCify) ❑ Other(SpeClfy) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.m innehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 3��, QOV • QO <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />