Laserfiche WebLink
� , City of Orono � <br /> � � . <br /> � Buildin Permit A lication � <br /> J pp <br /> for New Structures or Additions <br /> Mailing Address: Permit number: /S— /Q <br /> �Q A,O PO Box 66 4 <br /> `V Crystal Bay, MN 55323-0066 ^�I1� Date received: U '�(v—�S <br /> ���� <br /> StreetAddress:' Received by: � � <br /> yF ,� 2750 Kelley Parkwa �/� Plan review fee: l� <br /> c,` Orono, MN 55356 /� <br /> l�kESH04� Main: 952-249-4600 Total Fee: ��� S —U/O� <br /> Fax: 952-249-4616 www.ci.orono nin.us <br /> This application form must be completed in full and all required information must b�bmitted. �(TQJ <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �iQE,vC� L�E {� /��{`� .�1�'�� `� �� <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 I APPLI ANT IN ORMATION: <br /> Name: ' 0�'l �vTTC-2 cv.��rnu�r��N �� <br /> State License# ,3 D i'f Expiration Date: ` .3 Zo! <br /> Phone: cell �2.. L�Z_ 7 ,3 office <br /> Mailing Address: S � ' ` �C - /1 Cit r ,4�E ZIP: ,j( <br /> Contact Person: � Applicant is: �n ractor�/ Homeowner �c���ieo�e> <br /> Email and/or Fax: �� ,,� Ca��St�'��t���� . Luv�'� <br /> PROPERTY OWNfR INFOIj�MATION: �" <br /> Name: �/�li( �C�DrI� /''�0��.� 50��✓ <br /> Phone (day): �Z -- $�S--,�Z��'� <br /> Address: G,Z,S'c., �"���+/G�I C�1-C-1� D� • City: [��v.��� ZIP: <br /> Email and/or Fax <br /> ARCHITECT I 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 8� <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 �A detached garage ❑ Residence ❑ Private Sewer <br /> ❑ Other. (specify) ���L F�Wc. ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> �L��/�T0(� ❑ 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) �.O•�her(SpeCify�j <br /> 15320 Minnetonka Blvd lNI�/l,�Ur'L K-E��LL <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 p C) , 60 <br /> Packet Last Updated: August 2015 <br /> Page 21 <br />