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. City o� Orano �.� <br /> �c��le�i�� �ermit Applicati�� l < < � <br /> f�r �ev� �t�uctures or Addit��r�s � <br /> Mailing Address: <br /> Q,�T PO Box 66 Permit number: �p/�—Ud(�d g <br /> � l VQ Crystal Bay, MN 55323-006� Date received: /-.J-/� <br /> � Street Address:' (1 � ��� Received by: <br /> 2750 Kelle Parkwavii a <br /> y�. '� y -v � Plan review fee: �Jj,8� <br /> �` Orono, MN 55356 <br /> �'kfSH��� Main: 952-249-4600 Total Fee: � � 7��� <br /> Fax: 952-249-4616 w��nn�.ci.orono.rrin.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be retumed. (Please print) <br /> GENERAL INFORIVIATION: __ <br /> Job Site Address: �7"�,� �� �� �.t�.� <br /> Will this be a Parade of Homes, Remo elers Showcase ome or other Display Home? ❑ Yes � No <br /> If yes, a specia/event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will�e <br /> required unless applicant demonstrates sufficient on-sife parking is availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APP ICANT INFORMATION: . <br /> Name: � L ►/� (.r�� )5-��cl c�y�i , �-G- <br /> State License # Expiration Date: <br /> Phone: cell ,� ��_� ' , � office <br /> Mailing Address: �3 Z ��D '- Cit : Z�p; � �>� <br /> Contact Person: <: Applicant is: ontracto�, / Homeowner (Circle One) <br /> Email and/or Fax: �,f�s�-rp-.�r.� � m f�„� -- <br /> PROPERTY OWNERrjfIFORMATION: <br /> Name: ��;,('� L�� <br /> Phone (day): � ��7 '�6�- 0 3 uu <br /> Address: Z�3Z J� Cit : � Z1P: SSj`�' " <br /> Email and/or Fax <br /> ARCHITECT/ ENGIN ER INFORMATION: <br /> Name: r'�� �'Ch , <br /> Phone (day): !, <br /> Address: /G�3 1 J� � _ Cit :. ZIP:SS3r <br /> Email and/or Fax: __���� e. (\„l-i'hanta�� D6�,��,; � <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone(day): <br /> Address: _ Citv: ZIP• <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: ��t�'� .� r�z '� (�-� �� �- �-� -�'����-�,�C <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with �ccessory Bldg./Garage <br /> �Addition attached garage ❑ Deck <br /> ❑Accessory Building ❑ Sin le Famil with Public Sewer <br /> g y ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence <br /> ❑ Other:(specify) ❑Septic <br /> ❑ Multiple Family/Condo ❑ Retaining Wall(s) (Com�liance certificate <br /> ❑ Public 4-feet or greater may be required) <br /> **Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review 8�permits. ❑ Industrial ❑Warehouse <br /> Public Water <br /> Minnehaha Creek Watershed District(MCWD) Other: ( pecify) ❑ Other(Specify) <br /> 15320 Minnetonka Blvd;Minnetonka,MN 55345 ❑ Private Well <br /> Phone: 952-471-0590 / Fax: 952-471-0682 � <br /> www.minnehahacreek.ora ��1t,� '�-Yj,� �p <br /> Estimated Construction Valuation (excluding land) $ ��`�� <br /> Packet Last Updafed: January 2016 <br /> Page 21 <br />