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e � <br /> � � City of Orono <br /> ` Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: /�,�� g <br /> PO Box 66 Permit number: ` <br /> �O� C stal Ba MN 55323-0066• <br /> Q rY Y, Date received: <br /> Street Address:' ��;�(�� Received by: <br /> y ,� 2750 Kelley Parkway rv 1�� Plan review fee: <br /> �' � Orono, MN 55356 6 � n <br /> `�kESH���� Main: 952-249-4600 Total Fee: „( 15�, ?� <br /> Fax: 952-249-4616 ti^Jvv�Jv_a oror�o_�nr� 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: nI <br /> Job Site Address: 333 a��Gv�c� K-�. <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 Deparfinent and Gity Council approval 60 days prior to fhe event Shuttle bus service will be <br /> required unless applicant demonstrates s�cient on-site parking is available. Mon-permitted events will not be allowed. <br /> CONTRACTOR/APPLIC�41�T INFORAAA�ON:�O�,w� <br /> Name: ., �� <br /> State License# � Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Clrcle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFO�MATIQN: �_ <br /> Name: � � �1 0,�� � aw�-c.� <br /> Phone(day): ' 2 08 Y <br /> Address: � Ci : l� r� ZIP: �,3�/ <br /> Email and/or Fax --�.��� '33 c'n�e�..� - Cu� <br /> ARCHITECT/ENGINEER NFORMATION: <br /> ►vame: �,�f.c S Le►��-- <br /> Phone (day): 6(2 �Z� 5333 <br /> Address: 230� ha;�,�,�,� A,r City: /}�f+HC�.,�ol�i ZIP: S S�`/`'`� <br /> Email and/or Fax: — C,�1c �C�e�„�,� ,c c�-� <br /> PROJECT INFORMATION: Descri tion of ro'ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8� <br /> Water Supply <br /> ❑New Construction �ingle Family with ❑Accessory Bldg./Garage <br /> [►3�Addition attached garage ❑Deck ❑Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ ffice/Commercial <br /> ❑Relocation � �� 1 � detached garage [�Residence (�Private Sewer <br /> [�Other: (specify) N^� K' `� ❑Multipte Family/Condo ❑Retaining Wall(s) <br /> ��� � (�,� ❑ Public 4-feet or greater ❑ Public Water <br /> *"Any earth movement ma�i requir� ❑Commercial ❑Storage <br /> MCWD review 8 permits. ❑ Industria� ❑Warehouse [�Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑Othef: (speCify) ❑Other(speCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehanacreek.or <br /> Estimated Construction Valuation (excluding land) $ �,C S;UD U <br /> Packet Last Updated: Augusf 2015 <br /> Page 21 <br />