2016-01227 - attached deck - Laserfiche WebLink

Home Browse Search

� � City of Orono ' Building Permit Application � , � � for New Structures or Additions � � Mailing Address: s PO Box 66 Permit number: .� � � �-- , � ��Q Crystal Bay, MN 55323-0066 Date received: G Sfreet Address:� _ __' eceived by: y � y ,Z- 2750 Kelley Parkway `,I-�I�,rQ Plan review fee: � � �' c,` Orono, MN 55356 (�+� " �,,; "C , `AkfSHO�ti Main: 952-249-4600 Total Fee: - Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: �u�5�'.5 �(�E"JJ1(,j¢ �;�'t,�,� �� Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No 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 required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. CONTRACTOR I APPLICANT INFORMATION: Name: �CC"K k��/I�oL L�U1-Zpc°-�S , ' State License# C,�c,�i�)4 7 Expiration Date: _� ' _ Phone: cell 6"i� -3� office ��2- - Mailing Address: c� - �. Cit : "w �<rt,+n, ZIP: �' p Contact Person: • /}N2c�/' ,=1.,,/� �� Applicant is: Contrac / Homeowner (CircleOne) Email and/or Fax: •�qI�Z�C� a ( ' kPnr/�/ � C�� PROPERTY OWNER INFORMATION: Name: � c1'CO N�ZL N L�/Vl�/C l�}.S/1'IG(S.S�7t✓ Phone (day): �- � � Address: S 7�C C � -K Cit : ZIP: Email and/or Fax Vnn�.. luw �vt/` � C�rn � _ ARCHITECT/ENGINEER INFORMATION: Name: Phone (day): Address: City: ZIP: Email and/or Fax: ARCHITECT/ ENGINEER INFORMATION: Name: Phone (day): Address: City: ZIP: Email and/or Fax: PROJECT INFORMATION: Description of project: RE��/4C� �LCK �S?H SC/I��7� C-7�Ct��usC� Grat.rJ�� 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& Water Supply ❑ New Construction �Single Family with ❑ Accessory Bldg./Garage ❑Addition attached garage �Deck ❑ Public Sewer ❑Accessory Building ❑ Single Family with Office/Commercial ❑ Relocation detached garage ❑ Residence Septic ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) ( ompliance certificate ❑ Public 4-feet or greater may be required) "*Any earth movement may require ❑ Commercial ❑ Storage MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Public Water Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) ❑ Other(speCify) 15320 Minnetonka Blvd;Minnetonka,MN 55345 �P�ivate Well Phone: 952-471-0590 / Fax: 952-471-0682 www.minnehahacreek.orq Estimated Construction Valuation (excluding land) $ 'e��;00(� Packet Last Updated: January 2016 Page 21