2014-00242 - new structure - Laserfiche WebLink

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�� Cit of Orono �\ti� �� Y � ��J Building Permit Application � � for New Structures or Additions Mailing Address: �� _� '7 �Q A>O PO Box 66 Permit number: oC, `V Crystal Bay, MN 55323-0066 Date received: �—oZ�7-1 Street Address:� Received by: � �` ,� 2750 Kelley Parkway y�' c,` Orono, MN 55356 Plan review fee: � oZ- `1KfSH0�� Main: 952-259-4600 Total Fee: � � �7�' �g 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: �G-L � ��e<<` r \�'� � " Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o 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/APPLICANT INFORMATION: Name: � G��'i �/"1.r��:n�X;�' '`.�rl(� � ci:�� n�. State License# ��j uC� Expiration Date: _S 3 i ��'►5 Phone: cell r 3 - ��- < 7�(3 office `?��-- ��5 - `j j v� Mailing Address: U�i61� L ;�<�/� �� ''��t Cit � ' ��l ZIP: S S�l 3 G� Contact Person: e ' /�r�.N��-,e� Applicant is: Contractor Homeowner (Circle One) Email and/or Fax: _7`�r - �� S iG�N aso N s� ��M PROPERTY OWNER INFORMATION: Name: �� '-� f � .� � 1 � Uv` �- �� Phone (day): �JS�- �1�- 5a� Address: i�S! gY.= f��e• . ' City: %��f M°`'�� ZI P: .j S�/`�� Email and/or Fax s�aY('w'w .•1�� c c�;i-�o�`^ ARCHITECT/ ENGINEER INFORMATION: Name: �;.v�n /��c t-�`� 1-ec{K�"e Phone(day): (p�: - 3�S - �7 � Address: �7� �/1/J�rk�f S �- �$ N�� City: /�•�^{��v% S ZIP: S�y�'� Email and/or Fax: ,q��r-Pc� �j S,."ca n ��c�. :f�c�{ �.-L , � �s-. PROJECT INFORMATION: Description of project: 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& � � � � Water Supply �i�'New Construction Single Family with �'Residence ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer ❑Accessory Building ❑ Single Family with ❑ Deck ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse ❑ Public ❑ Storage ❑ Public Water '�Any earth movement may require ❑ Commercial ❑ Other(specify) MCWD review&permits. ❑ Industrial ❑ Private Well Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) 18202 Minnetonka Blvd Deephaven,MN 55391 Phone: 952-471-0590 Fax: 952-471-0682 www.minnehahacreek.or Estimated Construction Valuation (excluding land) $ � r� �G'L', �s v �j Packet Last Updated: 04/19/2013 Page 22 of 23