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City of Qrono � . 5 <br /> Building Permit Application%� <br /> � � 3 �� � <br /> for New Structures or �,dditions -' <br /> Mailing Address: Permit number: ��'�'.� � <br /> ��A rO PO Box 66 <br /> !V Crystal Bay, MN 55323-0066 Date received: �7 <br /> Street Address:' Received by: <br /> y ,� 2750 Kelley Parkw �,.f J��j� Plan review fee: <br /> �c,` Orono, MN 55356 ��`''� 2 Z <br /> F`�kFSHO� Main: 952-259-4600 !5 <br /> Fax: 952-249-4616 wwv�.ci.orono.mn.us ' (,�. �, i �� '�""�' <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: � �d �, <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> lf 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 wil/not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: (��v��vcf �7 �,�,� Ex�� l��-r�S �NL <br /> State License# i3c (� ��,�, 6� Expiration Date: 3%3i��G <br /> Phone: (cell) --7�,,3 �,y c���53 j (office) y 5��, ��� � g� �"� <br /> Mailing Address: , � < <- � � 6 Cit : � r ZIP: � '3�-� <br /> Contact Person: �=} � � y L Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: �15�, �� �— � S�� <br /> PROPERTY OWNER INFORMATION: <br /> Name: R�rarvc-e.:-� t-4.;r+-,� �xr�,z� �-.z�, s �-r L. <br /> Phone (day): 7�� y y�j S 3 S <br /> Address: �� 6i �,.�r�-i2.aTr.� t��o ,� � s%r� i L�7 City: �►�2�:-►!� ZIP: �� 3�/J <br /> Email and/or Fax o��,���.,� c� �o „� � �c ��.��� ! C.��.,r� <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: 3�N-2 'C�� St U�; <br /> Phone (day): C�.S�- 7y��Z�a � <br /> Address: City: ZIP: <br /> Emailand/orFax: C� �� 7•�(n— -7�70'3 tMIt�CE� � i�F`r��Z ���A�r;r�(�-c�r,� 4FS�c..r1. <br /> �- c�� <br /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> ��lew Construction �,'Single Family with ❑ Accessory Bldg./Garage <br /> ❑Addition attached garage eck �ublic Sewer <br /> ❑Accessory Building ❑ Single Family with �Office/Commercial <br /> ❑ Relocation detached garage �Residence ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater �ublic 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 � � � ��:;' �� <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />