Laserfiche WebLink
� City of Orono . ��•�� �r <br /> , � Building Permit App�ication � �,tl.-�Or�s3 <br /> � <br /> far° t��w Structures ar Additio�s <br /> Mailing Address: �� _ <br /> ��A r PO Box 66 •/��� ��i number: p�/�,r� <br /> � C stal Ba MN 55323-0066 <br /> VD rY Y� Date received: � �'��'"�� <br /> Street Address:' Received by: � <br /> � ,� 2750 Kelley Parkway aQ/�..of�1_ <br /> 6�, � Plan review fee: tiP <br /> L Orono, MN 55356 <br /> �'�XFSHo�``` Main: 952-249-4600 !/Lj�� �� <br /> Total Fee: <br /> Fax: 952-249-4616 v✓ww.ci.orono.mn.us �� � <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: J�3 S j.,�e �;�,�E C,� <br /> Will this be a Parade of Homes, Remodelers Sh wo case Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a special event permit is required with Police Department and City Council approva/60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted evenfs will not be allowed. <br /> CONTRACTOR/APP ICANT INFOJ,2M�4TION: <br /> Name: 5�.��r,� fi a e�r M�„� <br /> State License# (�`3 Expiration Date: 3 <br /> Phone: cell !� � - �z office <br /> Mailing Address: ��a 7 F�o �--� C:-c/ Cit : ., s �/� ZIp: S'��.{� <br /> Contact Person: C Applicant is: Contrac o / Homeowner (Circle One) <br /> Email and/or Fax: S M �� , , �r r-� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ���� Fi-r'tZ <br /> Phone (day): <br /> Address: /o��' ..� T�y e C,�/ City: '11�y Z�► 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 /> ARCHITECT/ ENGINEER INFORMATION: 1�I � <br /> Name: � <br /> Phone (day): <br /> Address: Cit : ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATI : Des ' ion of project: � ! r �� '� `� �' � n 1,'�,�� <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑ New Constructio ❑ 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 ❑ Septic <br /> � Other: (specify) . �.�_ ❑ Multiple Family/Condo ❑ Retaining Wall(s) (Compliance certificate <br /> ❑ Public 4-feet or greater may be required) <br /> *"Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse <br /> ❑ Public Water <br /> Minnehaha Creek Watershed District(MCWD) ❑ Othef: (specify) ❑ Other(SpeCify) <br /> 15320 Minnetonka Blvd; Minnetonka,MN 55345 ❑ Private Well <br /> Phone: 952-471-0590 I Fax: 952-471-0682 <br /> www.m innehahacreek.orq <br /> Estimated Construction Valuation (excluding land) $ S�S p o�. -- <br /> . <br /> Packet Last Updated: January 2016 �• ,� r <br /> Page 21 V <br />