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City of Orono � <br /> � � � . <br /> Buildin Permit A lication � <br /> . J pp <br /> for New Structures or Additions <br /> Mailing Address: Permit number: /,_$- /Q <br /> �A, PO Box 66 <br /> � �v� Crystal Bay, MN 55323-0066 ,,I�� Date received: U �-�(o-)S <br /> Street Address:' �'���, ceived by: � � <br /> � 2750 Kelley Parkwa � <br /> ti�, � � Plan review fee: . <br /> c.` Orono, MN 55356 <br /> __. _ , <br /> 9kESH��� Main: 952-249-4600 Total Fee: �Q� S -UI�� <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must b�bmitted. �� <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �iQE,tJC�f' C��j� /�,'(/E d�-o.�✓ v �� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display ome? ❑ Yes No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLI ANT IN ORMATION: <br /> Name: �/►�I ��7TE2 C-Os+��2ucT'i�N �.�(.� <br /> State License# 3 0 �y Expiration Date: ,3 Zo� <br /> Phone: cell �Z. L$Z_ 7 office <br /> Mailing Address o /l. Cit ,¢� ZIP: �j <br /> Contact Person: � Applicant is: � racto�/ Homeowner (Circle One) <br /> Email and/or Fax: W� � Coi15t�"��'7�%u c� . �oN� <br /> PROPERTY OWNfR INFO MATION: <br /> Name: b d/1/ <br /> Phone (day): -- � -.� 7 <br /> Address: /�,5� F'/lE,✓G�1 C�.�/� n/� . City: �,i(�v ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <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 /> ❑ 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) �/�'Wf)�L �QIZ ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> �L�tJ/�T02 ❑ 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) �O her(specify�j <br /> 15320 Minnetonka Blvd ���/l,`Ul'Z K�EI�Oi]�L <br /> Minnetonka,MN 55345 "— <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �� Q 0 V . BC> <br /> Packet Last Updated.• August 2015 <br /> Page 21 <br />