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. City of Orono <br /> ' Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: Qlj�--���'�j' <br /> � �Q PO Box 66 <br /> � Crystal Bay, MN 55323-0066 Date received: 'j��O` <br /> StreetAddress:' Received by: � <br /> � ,� 2750 Kelley Parkway � <br /> y�' �` Orono, MN 55356 �. ��G �55�(p Plan review fee: s�. � <br /> !�'FESHOR� Main: 952-249-4600 Total Fee: a !`S�`�l � <br /> Fax: 952-249-4616 www.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)��-�,p �,5-pD S� 5` - <br /> GENERAL INFORMATION: <br /> Job Site Address: �t�C� Kt,n,�w� �.avl� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> 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 <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPL1,CANT INFORM�QTION: <br /> Name: C9-o h e�l ���' <br /> State License# � S Expiration Date: <br /> Phone: cell �'a--'7 �- v�, office <br /> Mailing Address: Gf4"a-- Q o h cw� 6}�w<< Cit : (.-o �� �, �c IP: <br /> Contact Person: ��-1�v� Applicant is: ractor Home wner (Circle One) <br /> Email and/or Fax: � �qy� oCqOtiY�c`l�crv�neS. fOW� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��-o t1v�� ��v�e S <br /> Phone (day): <br /> Address: City: 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 /> PROJECT INFORMATION: Description of project: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal& <br /> Water Supply <br /> ew Construction Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck <br /> ❑ Accesso Buildin ❑ Public Sewer <br /> ry g ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence Private Sewer <br /> ❑ Other:(specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse rivate Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other:(SpeCify) ❑ Other(SpeCify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �c� Qa� <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />