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, ' City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: �°Jr` � � <br /> �D�O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' �_ ceived by: <br /> � ,� 2750 Kelley Parkway u"\�� �8' <br /> yF c,` Orono, MN 55356 � P review fee: <br /> `qkESH��� Main: 952-249-4600 T tal Fee: ' �� '��� <br /> Fax: 952-249-4616 �vvt�s:.ci.oronu.n�in us <br /> This application form must be completed in full and all required information mus be sub � ed. rt�l��,,, <br /> Incomplete applications will be returned. (Please print) (,,,1r.s�'r Y%��/�— <br /> GENERAL INFORMATION: , /" � [ tJ��� � � <br /> Job Site Address: � �� <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 approval 60 days prior to the event. Shuttle bus service ill <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP�CA�T�NFO MATION: ��n �mM� n ��' <br /> Name: � v�� r vw <br /> State License# C p / Expiration Date: — - <br /> Phone: cell , - office S,2 -„� <br /> Mailing Address: Cit : > ZIP: � ,�'' -�',,,,'�' <br /> Contact Person: � Applicant is: ontractor / Homeowner (Circle One) <br /> Email and/or Fax: ����_p� � �� o� ��,�� r �f � �i�t,-, <br /> PROPERTY OWNER INFOR TION: <br /> Name: Q C <br /> Phone (day): - j - <br /> ,� Cit : � �r� ZIP:��{� �, <br /> .i i�`.l <br /> • � % �} <br /> / / <br /> I <br /> / �ff Ko y�z-y4y_� <br /> nen M�b,�e �, <br /> nc�r�llcon��r�tnr 612-.sti�_ City: ZIP: <br /> _---�__ .Ikunen�ko �'�'; <br /> nenhon�r.,,,� <br /> ��o`��� pee� � <br /> �ha��e�, �1�,� ,, � oject: � � �� � � ���� ���' <br /> osed Use 3. Structure Type 4. Sewage isposal & <br /> Water Supply <br /> ❑ New�����.._ �le Family with Accessory Bldg./Garage <br /> ❑Addition ached garage ck ❑ Public Sewer <br /> �AccEssory Building �_ ngle Family with ❑ Office/Commercial <br /> �❑�2elocation detached garage ❑ Residence ❑ 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 8�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) $ �/� "` <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />