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� <br /> � ' � RECEIVED <br />� City of Orono �A� � � ���� <br /> Building Permit Application CITYOFORONO <br /> for New Structures or Additions <br /> Mailing Address: Permit number: ���0—Dd�Q <br /> ��Q A.� PO Box 66 <br /> � �V� \ Crystal Bay, MN 55323-0066 Date received: 5 3�-'��o <br /> 1 <br /> f� StreetAddress:' _ Re ived by: - N <br /> ___ <br /> 4\':y ,� 2750 Kelley Parkway q� `� --- -- - <br /> �` 1 �� k Z �a�review fee: '9' O, Cp _.� <br /> ,c. Orono, MN 55356 � <br /> �K�s r�o��" Main: 952-249-4600 f�-C _ ___ .,....__ p�.(,j(P—�C� 3 : <br /> -..,,_.v._�,,� Total Fee: - <br /> Fax: 952-249-4616 www.ci.orono.mn.us \ : ! g <br /> This application form must be completed in full and all required information must be submitted. ,� �D <br /> Incomplete applications will be returned. (Please print) �h'`S y <br /> GENERAL INFORMATION: (��if��j� <br /> Job Site Address: � -�7 i ca K � � (�� ,� ;� <br /> Will this be a Parade of Homes, Remodelers Sho case Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a specia/event permit is required with Po/ice 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 availab/e. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: P�����_-��-� ��.;2�,- <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: City: ZIP� <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: �1�c�;� i w1 `��—�1<�c_.l-� <br /> Phone (daY): C.v IL;� -���C�- c9�"1 '�? / <br /> Address: '�,U�U S Yl6y"�I�YIF, c�. r'i v'�-- City: (,�.�-t,j,�2,,tZL ZIP: S�3G � <br /> Email and/or Fax ��-y�, ,� �;-{--�; I � �-{-� �i.' �-� r� , c'_<� r? � <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: Cit : ZIP� <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro ect: I�`,������ <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> ❑ New Construction Sin le Famil with Water Supply <br /> g y ❑Accessory Bldg./Garage <br /> �Addition attached garage ❑ Deck 0'�ublic Sewer <br /> ❑Accessory Building ❑ Single Family with ❑O�ce/Commercial <br /> ❑ Relocation detached garage �esidence <br /> ❑ Other: (specify) ❑ Private Sewer <br /> ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater [.��rblic Water <br /> "'Any earth movement may require ❑Commercial ❑Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑ Other(speCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> P hone: 952-471-0590 <br /> Fax: 952-471-0682 ; <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �S C.� n�� <br /> Packet Last Updated: August 2015 � <br /> Page 21 <br />